Thyrotoxicosis following SARS-COV-2 vaccination: a case series and discussion.

AIM: To describe a case series of thyrotoxicosis likely triggered by SARS-CoV-2 vaccination and to warn physicians about this potential correlation. To report clinical, laboratory and imaging findings and provide further information that goes in line with the underlying mechanisms. METHODS: Single-center case series based on all the information collected in the hospital medical records, as well as the temporal sequence between the onset of symptoms and COVID-19 vaccination. RESULTS: We report 8 cases with thyrotoxicosis after SARS-CoV-2 vaccination. 4 cases of Graves' disease (GD), 2 cases of subacute painful thyroiditis (SAT), 1 case of concurrent GD and SAT and 1 case of atypical subacute thyroiditis. Five patients received BNT162b2 mRNA vaccine, 3 patients 1273 mRNA vaccine. The onset of symptoms following vaccination ranged from 10 to 14 days in six of eight patients and from 7 to 8 weeks in two patients. CONCLUSIONS: Several hypotheses have been proposed to explain the potential correlation between SARS-CoV-2 vaccination and thyrotoxicosis, including immune system hyper-stimulation, molecular mimicry and Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). We should pay greater attention to thyroid disorders in patients receiving vaccine against SARS-CoV-2.

Extracellular vesicles released by steatotic hepatocytes alter adipocyte metabolism.

The composition of extracellular vesicles (EVs) is altered in many pathological conditions, and their molecular content provides essential information on features of parent cells and mechanisms of crosstalk between cells and organs. Metabolic Syndrome (MetS) is a cluster of clinical manifestations including obesity, insulin resistance, dyslipidemia and hypertension that increases the risk of cardiovascular disease and type 2 diabetes mellitus. Here, we investigated the crosstalk between liver and adipocytes by characterizing EVs secreted by primary hepatocytes isolated from Zucker rat model, and studied the effect they have on 3T3-L1 adipocytes. We found that steatotic hepatocytes secrete EVs with significantly reduced exosomal markers in comparison with their lean counterpart. Moreover, proteomic analysis revealed that those EVs reflect the metabolic state of the parent cell in that the majority of proteins upregulated relate to fat metabolism, fatty acid synthesis, glycolysis, and pentose phosphate pathway. In addition, hepatocytes-secreted EVs influenced lipolysis and insulin sensitivity in recipient 3T3-L1 adipocytes. Untargeted metabolomic analysis detected alterations in different adipocyte metabolic pathways in cells treated with hepatic EVs. In summary, our work showed that steatosis has a significant impact in the amount and composition of EVs secreted by hepatocytes. Moreover, our data point to the involvement of hepatic-EVs in the development of pathologies associated with MetS.

More Than 1000 Kidney Transplants Performed in Pamplona, Navarra: Data From the Collaborative Transplant Study.

INTRODUCTION: The Kidney Transplant Program started at the Clinica Universidad de Navarra (Pamplona, Spain) in September of 1969. The 1000th kidney transplant was performed in September 2015. Data from kidney transplants have been included in the Collaborative Transplant Study since 1983. MATERIALS AND METHODS: Data on patient and graft survival of the 635 kidney transplants (557 first kidney transplants and 78 second kidney transplants) performed in the Clinica Universidad de Navarra between 1990 and 2014, as well as the estimated average life of the grafts are described and compared with data from the more than 150,000 European kidney transplants included in the Collaborative Transplant Study in the same period. RESULTS: Data of our patient and graft survival are statistically significantly better (P < .05) than those of the over 150,000 European transplants analyzed in the Collaborative Transplant Study in the same period. The estimated half-life of the kidney transplants performed in our Center is 18.5 years for first transplants and 15.7 years for second transplants, compared to 13.9 and 11.2 years, respectively, calculated for the European transplants. CONCLUSIONS: Data obtained from the Collaborative Transplant Study confirm excellent graft survival in our Center with an estimated half-life higher than that of the European transplants included in this study.

Short-Term Outcomes of 100 Consecutive Kidney Transplantations in a 3-Year Period: A Single-Center Experience.

BACKGROUND: The results of kidney transplantation have improved significantly in the last decade with patient and graft survival rates that range from 92% to 95%. METHODS: We analyzed the clinical results in the last 100 consecutive patients with a follow-up of 6-42 months at our institution. We also made a general evaluation of the patients before surgery as candidates for transplantation and divided them into 3 groups (good, moderate, and poor). RESULTS: We had 8 living donors and 92 cadaveric kidney transplantation cases. Principal cause of donor death was cerebrovascular disease accounting for 64%. Mean age of recipients was 55.1 ± 12.9 years with a total of 65 males. Currently there are 96 functioning allografts. During this 3-year period, 2 patients suffered graft loss and 2 patients died with a functioning allograft. We studied whether there were statistically significant differences in renal function (Modification of Diet in Renal Disease Study Equation [MDRD]) at 12 months and at last visit with respect to the evaluation of recipient as candidate for renal transplantation. CONCLUSION: Our observations suggest great improvement of early results of renal transplantation in recent years, including complex cases. In this 3-year period we had a patient survival rate of 98% and a graft survival rate of 96% of cases. Further dedicated prospective studies that aim to evaluate or to propose possible recipient-related predictors for kidney transplantation outcomes in different populations are needed.

Circulating RNA: looking at the liver through a frosted glass.

CONTEXT: The evaluation of the liver condition, based on serum enzymatic activity and biopsies, is insufficient. Therefore, it is a priority to find a correlation between circulating RNAs and liver damage. METHODS: Publications were retrieved by the search terms "circulating RNA AND liver". RESULTS: Although differences exist between studies, a profile of RNAs that repeatedly appeared as indicators of liver damage was identified. DISCUSSION: We highlight those circulating RNAs useful to diagnostic, and discuss the transport mechanisms. CONCLUSION: Several studies have proven that circulating RNAs are useful to establish a diagnostic and a prognosis of liver diseases.

Resultados de la resección transuretral (RTU) de malla intravesical tras tratamiento con cintillas suburetrales para la incontinencia urinaria de esfuerzo / Outcomes of transurethral resection (TUR) of intravesical mesh after suburethral slings in the treatment of urinary stress incontinence

Objetivo: El objetivo de este estudio fue determinar la eficacia y las complicaciones asociadas con la resección transuretral (RTU) de malla intravesical después de la cirugía con TOT (Monarc(TM)) o «minisling» (MiniArc(R)) para tratar la incontinencia urinaria de esfuerzo femenina (IUE). Material y métodos: Estudio retrospectivo de 9 mujeres consecutivas, todas ellas con perforación intravesical de cintilla suburetral: 3 en pacientes tratadas con cabestrillo transobturador, Monarc(TM) y 6 en pacientes con «minisling», MiniArc(R). Todas las pacientes fueron tratadas con RTU con asa con energía bipolar. La técnica incluye la identificación de la malla intravesical, la eliminación completa con el resector de energía bipolar hasta que no era visible más malla y se alcanzó el tejido sano perivesical. Resultados: La edad media de nuestras pacientes fue de 61 años. El tiempo medio de aparición de síntomas tras la cirugía por IUE fue 13 meses (1-79) y el tiempo medio hasta la RTU de 16 meses (1-91). Cinco mujeres (55,5%), desarrollaron litiasis vesicales. El tiempo de operación promedio fue de 29,4 ± 10,4 min y la estancia media hospitalaria fue de 2,6 ± 0,5 días. La mediana de seguimiento fue de 38 meses (rango: 14-109 meses) después de la eliminación de malla. No se encontraron complicaciones. Conclusión: El uso de la resección transuretral para tratar las perforaciones vesicales tras cirugía vaginal con malla es fácil de realizar y en nuestro grupo tiene excelentes resultados

Objective: The objective of this study was to determine the efficacy as well as the complications associated with transurethral removal (TUR) of intravesical mesh after suburethral sling, transobturator tape-TOT (Monarc(TM)) or 'minisling' (MiniArc(R)), in the treatment of female urinary stress incontinence (USI). Material and methods: retrospective and consecutive study on 9 women with bladder perforation after midurethral slings (3 Monarc(TM) and 6 MiniArc(R)) placement for urinary stress incontinence. To remove the mesh, transurethral resection with an electrode loop (TUR-E) was used. The technique included: location and total removal of mesh with bipolar resectoscope up to healthy tissue. Results: The median age was 61 years (49-70 years). The median time between midurethral sling placement and onset the sympltoms was 13 months (1-79 months). and between sling placement and mesh removal was 16 months (1-91 months). Five women (55.5%) developed bladder stones. Mean operating time was 29.4 ± 10.4 minutes and mean length of hospital stay was 2.6 ± 0.5 days. The median follow-up after mesh removal was 38 months (range, 14 to 109 months). No complications were found. Conclusions: The use of transurethral resection of intravesical mesh after suburethral slings is easy and the results obtained by our surgical team are excellent

Outcomes of transurethral resection (TUR) of intravesical mesh after suburethral slings in the treatment of urinary stress incontinence.

OBJECTIVE: The objective of this study was to determine the efficacy as well as the complications associated with transurethral removal (TUR) of intravesical mesh after suburethral sling, transobturator tape-TOT (Monarc™) or "minisling" (MiniArc(®)), in the treatment of female urinary stress incontinence (USI). MATERIAL AND METHODS: retrospective and consecutive study on 9 women with bladder perforation after midurethral slings (3 Monarc™ and 6 MiniArc®) placement for urinary stress incontinence. To remove the mesh, transurethral resection with an electrode loop (TUR-E) was used. The technique included: location and total removal of mesh with bipolar resectoscope up to healthy tissue. RESULTS: The median age was 61 years (49-70 years). The median time between midurethral sling placement and onset the sympltoms was 13 months (1-79 months). and between sling placement and mesh removal was 16 months (1-91 months). Five women (55.5%) developed bladder stones. Mean operating time was 29.4 ± 10.4 minutes and mean length of hospital stay was 2.6 ± 0.5 days. The median follow-up after mesh removal was 38 months (range, 14 to 109 months). No complications were found. CONCLUSIONS: The use of transurethral resection of intravesical mesh after suburethral slings is easy and the results obtained by our surgical team are excellent.

Tratamiento de la incontinencia urinaria de esfuerzo femenina mediante cintillas suburetrales: estudio retrospectivo comparativo observacional de 2 técnicas quirúrgicas / Treatment of Female Stress Urinary Incontinence Using Suburethral Slings: Comparative, Retrospective, Observational Study of Two Surgical Techniques

Objetivo: El tratamiento de la incontinencia urinaria femenina ha sufrido una revolución en los últimos años por la aparición en el mercado de las cintillas suburetrales. El objetivo de este estudio es comparar 2 técnicas quirúrgicas para el tratamiento de la incontinencia urinaria de esfuerzo: Monarc™ (cintilla suburetral transobturadora) y MiniArc® (mini-cintilla suburetral de incisión única). Material y métodos: Estudio retrospectivo observacional comparativo desde enero de 2005 hasta diciembre de 2011 con 317 mujeres diagnosticadas de incontinencia urinaria de esfuerzo. Doscientas catorce fueron tratadas con la cintilla suburetral transobturadora Monarc™ y 103 con la mini-cintilla MiniArc®. Los resultados han sido tratados con el programa informático SPSS v 15 y el nivel de significación estadística ha sido p ≤ 0,005. Resultados: Los 2 grupos de pacientes son homogéneos en cuanto a la edad, el número de partos, la presencia de incontinencia urinaria de urgencia o histerectomía previa. Diferencias significativas en estancia hospitalaria, tiempo quirúrgico y complicaciones precoces a favor del Miniarc®, pero no en las tardías donde no hay diferencias significativas globales. El 84% de las pacientes tratadas con la cintilla transobturadora Monarc™ están curadas frente al 72% en las que colocamos un MiniArc® con diferencia significativa. Conclusión: Debemos realizar un mayor número de estudios de alta calidad de carácter prospectivo y aleatorizados, con mayor número de pacientes y tiempo de seguimiento para confirmar o rechazar la diferencia que hemos encontrado en la tasa de éxito a favor de cintilla suburetral transobturador Monarc™ (AU)

Objective: The treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc® (single-incision suburethral mini-sling). Material and methods: Comparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc® mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P ≤ 0.005. Results: The two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc®, technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc®, a difference that was statistically significant. Conclusion: We need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling (AU)

Treatment of female stress urinary incontinence using suburethral slings: comparative, retrospective, observational study of two surgical techniques.

OBJECTIVE: The treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc(®) (single-incision suburethral mini-sling). MATERIAL AND METHODS: Comparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc(®) mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P≤.005. RESULTS: The two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc(®), technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc(®), a difference that was statistically significant. CONCLUSION: We need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling.

Fascitis necrotizante causada por Vibrio vulnificus / Necrotising fasciitis caused by Vibrio vulnificus

No disponible

Concentration compared with total urinary excretion of 11,17-DOA in cynomolgus monkey urine.

Strees sensitive molecules exhibit great variation in concentration in the circulation and it may often be advantageous to quantify these in urine or feces rather than in serum or plasma. We advocate that all urine-or feces-should be collected, and that excretion of stress sensitive molecules should be expressed as amounts excreted per time unit per kg body-weight, rather than being expressed as concentrations in samples. Urine and feces excretion varies significantly within and between animals over time, which may render simple concentration measures of molecules of little biological relevance.

Stress in cynomolgus monkeys (Macaca fascicularis) subjected to long-distance transport and simulated transport housing conditions.

The stress associated with transportation of non-human primates used in scientific research is an important but almost unexplored part of laboratory animal husbandry. The procedures and routines concerning transport are not only important for the animals' physical health but also for their mental health as well. The transport stress in cynomolgus monkeys (Macaca fascicularis) was studied in two experiments. In Experiment 1, 25 adult female cynomolgus monkeys were divided into five groups of five animals each that received different diets during the transport phase of the experiment. All animals were transported in conventional single animal transport cages with no visual or tactile contact with conspecifics. The animals were transported by lorry for 24 h at ambient temperatures ranging between 20 degrees C and 35 degrees C. Urine produced before, during and after transport was collected and analysed for cortisol by enzyme-linked immunosorbent assay (ELISA). All monkeys exhibited a significant increase in cortisol excretion per time unit during the transport and on the first day following transport.Although anecdotal reports concerning diet during transport, including the provision of fruits and/or a tranquiliser, was thought likely to influence stress responses, these were not corrobated by the present study. In Experiment 2, behavioural data were collected from 18 cynomolgus macaques before and after transfer from group cages to either single or pair housing, and also before and after a simulated transport, in which the animals were housed in transport cages. The single housed monkeys were confined to single transport cages and the pair housed monkeys were kept in their pairs in double size cages. Both pair housed and singly housed monkeys showed clear behavioural signs of stress soon after their transfer out of their group cages.However, stress-associated behaviours were more prevalent in singly housed animals than in pair housed animals, and these behaviours persisted for a longer time after the simulated transport housing event than in the pair housed monkeys. Our data confirm that the transport of cynomolgus monkeys is stressful and suggest that it would be beneficial for the cynomolgus monkeys to be housed and transported in compatible pairs from the time they leave their group cages at the source country breeding facility until they arrive at their final laboratory destination in the country of use.

Megauréter primario con obstrucción / Primary megaureter and obstruction

No disponible

Mediastinitis secundaria a perforación esofágica yatrogénica / No disponible

No disponible

El marcapasos en la Torsade de Pointes: ¿un arma terapéutica o etiológica? / The pacemaker implantation in the Torsade de Pointes: a therapeutic or ethiologic weapon?

La torsade de pointes (TdP) es una causa frecuente de muerte súbita de origen cardiaco, sin embargo, su electrofisiología y tratamiento no están todavía claramente establecidos. Comunicamos el caso de una paciente portadora de marcapasos que presentó varios episodios de taquicardia helicoidal o TdP, que fueron eficazmente corregidos con sobreestimulación cardiaca de su marcapasos y sulfato de magnesio iv. La causa de la prolongación del QT y el inicio de esta arritmia pudo estar favorecido por la estimulación epicárdica de su marcapasos. Queremos incidir en la sobreestimulación cardiaca como tratamiento eficaz de la TdP, y en la necesidad de valorar el riesgobeneficio en la implantación de determinados tipos de marcapasos en pacientes con riesgo de prolongación del intervalo QT y muerte súbita secundaria a TdP (AU)

The Torsade de pointes (TdP) is a frequent cause of sudden death of cardiac origin, however, its electrophysiology and treatment are not still clearly established. We communicate a case of a patient with pacemaker implantation that presented various episodes of Torsade of Pointes (TdP) those were efficiently corrected with overdrive pacing and sulphate of magnesium iv. The cause of the prolonged QT interval and the start of this arrhythmia could be favored by the stimulation in epicardium of its pacemaker. We want to impact in the overdrive pacing as efficient treatment of the TdP, and we must value the risk-benefit in the establishment of determined pacemaker’s types in patients at the risk of prolonged QT interval and secondary sudden death by TdP (AU)

[TRUS-guided biopsy: comparison of two anesthetic methods]. / Biopsia prostática ecodirigida: comparación de dos métodos anestésicos.

PURPOSE: The aim of the present study is to compare two analgesic techniques for ultrasound transrectal biopsy. Oral analgesia vs periprosthetic nerve blockade with 2% mevicaine. PATIENTS AND METHODS: A total of 200 patients were randomized prospectively into 2 groups, namely group I: 100 patients treated with metamizol, oral morphine 30 minutes before the procedure, and group II: 100 patients anesthesied with periprosthetic nerve blockade with 2% mepivacaine. Both groups were treated with bromacepán 3 mg 30 minutes before the biopsy. The first intention was to obtain 10 core TRUS-guided biopsy in all patients underwent. After the procedure, a ten visual analogue pain score (VAS) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained. Test T de Student was used for statistical analysis. RESULTS: There were no significant differences in age, PSA and prostate volume. 3 core TRUS-guided biopsy were obtain in group I (3 +/- 1.3), and 10 in group II (5 +/- 1.2) In the periprosthetic block group (II) 95% of patients referred no pain after the procedure (VAS = 0), 2% middle pain (VAS = 5-6) and 3% strong pain (VAS = 7-8); while patients in group I referred 12.5% no pain, 42.4% middle pain, 20% strong pain. The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostate biopsy with periprosthetic nerve blockade. (p < or = 0.05). There were no significant differences in major complications. CONCLUSIONS: The use of bilateral periprosthetic block with mepivacaine is a very effective and useful technique, well tolerated by the patient, which almost completely abolishes the pain and discomfort associated with the prostate biopsy procedure. And also allows increase the number of cores.

[Laparoscopic treatment of ovarian vein syndrome]. / Tratamiento laparoscópico del síndrome de la vena ovárica.

OBJECTIVE: We report a case of Ovarian Vein Syndrome, describe its clinical symptoms and discuss its diagnosis and management including laparoscopic surgery treatment. MATERIALS AND METHODS: A 36-year-old female with right kidney recurring pain was studied by means of abdominal RX, urography, CT, MRI and ultrasonography and finally diagnosed from Ovarian Vein Syndrome. The case was resolved with laparoscopic surgery. CONCLUSIONS: Ovarian Vein Syndrome is an uncommon disorder. Differential diagnosis must be done with external processes that cause ureteral obstruction. Surgery is the first line treatment when clinical symptoms are present and, in our opinion,laparoscopic surgery is the best approach to treat this pathology.

Biopsia prostática ecodirigida: comparación de dos métodos anestésicos / Trus-guided biopsy: camparison of two anesthetic methods

Introducción: La intención de este estudio es comparar la efectividad de dos técnicas analgésicas, una oral frente al bloqueo con anestesia local de los nervios periprostáticos, en la realización de la biopsia prostática ecodirigida. Material y métodos: Un Total de 200 pacientes se han randomizado en dos grupos. Grupo I: 100 pacientes tratados con metamizol y morfina oral 30 minutos antes de la realización de la biopsia. Grupo II: 100 pacientes a los que se los ha anestesiado con mepivacaína al 2% en las bandeletas. Previamente a ambos grupos de pacientes se les suministró bromacepán 3 mg 30 minutos antes de la prueba. Después de la biopsia a los pacientes se les pidió que graduaran su dolor mediante una escala analógica visual, graduada de 0 (no dolor) a 10 dolor insoportable. Los datos obtenidos se manejaron estadísticamente con el test T de Student. Resultados: Ambos grupos no presentaron diferencias significativas con respecto a la edad, PSA y volumen prostático. Se obtuvieron en el grupo I, 3 biopsias por lóbulo (3+/-1,3), y en el II grupo 5 (5+/-1,2). En éste grupo el 95% de los pacientes no experimentaron dolor alguno tras la biopsia (VAS = 0), el 2% un dolor moderado (VAS=5-6), y el 3% un dolor intenso (VAS=7-8). Los pacientes del grupo I refirieron ningún dolor en 12,5%, dolor moderado el 42, 4% , y dolor intenso el 20% . Encontrándose diferencia significativa entre ambos grupos (p<=0,05) con respecto al dolor, pero no con respecto a las complicaciones referidas. Conclusión: La biopsia de próstata ecodirigida es una prueba muy bien tolerada bajo anestesia local con mepivacaína, disminuyendo el dolor asociado a la biopsia, lo cual permite realizar en el mismo acto una mayor toma de cilindros

Purpose: The aim of the present study is to compare two analgesic techniques for ultrasound transrectal biopsy. Oral analgesia vs periprosthetic nerve blockade with 2 % mevicaine. Patients and methods: A total of 200 patients were randomized prospectively into 2 groups, namely group I: 100 patients treated with metamizol, oral morphine 30 minutes before the procedure, and group II: 100 patients anesthesied with periprosthetic nerve blockade with 2% mepivacaine. Both groups were treated with bromacepán 3 mg 30 minutes before the biopsy. The first intention was to obtain 10 core TRUS-guided biopsy in all patients underwent. After the procedure, a ten visual analogue pain score (VAS) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained. Test T de Student was used for statistical analysis. Results: There were no significant differences in age, PSA and prostate volume. 3 core TRUS-guided biopsy were obtain in group I (3+/-1,3), and 10 in group II (5+/-1,2) In the periprosthetic block group (II) 95% of patients referred no pain after the procedure (VAS = 0), 2% middle pain (VAS=5-6) and 3% strong pain (VAS=7-8); while patients in group I referred 12,5% no pain , 42,4% middle pain, 20% strong pain. The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostate biopsy with periprosthetic nerve blockade. (p<=0.05). There were no significant differences in major complications. Conclusions: The use of bilateral periprosthetic block with mepivacaine is a very effective and useful technique, well tolerated by the patient, which almost completely abolishes the pain and discomfort associated with the prostate biopsy procedure. And also allows increase the number of cores