[Laparoscopic placement of peritoneal dialysis catheter: description and results of a two-port technique]. / Colocación de catéter de diálisis peritoneal por laparoscopia: descripción y resultados de una técnica propia de dos puertos.

AIM: To test the feasibility, efficacy and safety of a new two port laparoscopic technique for dialysis catheter placement. MATERIAL AND METHODS: From January 2006 to July 2009 51 patients underwent dialysis catheter placing using an original technique. All procedures were finished laparoscopically using two 12 mm-sized ports. Our technique bases on placing Oreopoulos-Zellerman catheter along a straight Guyon s guide with atraumatic tip, visually guaranting optimal placement. Catheter can be repositioned if desired by reentering the guide. Median follow-up was 25 months. RESULTS: Mean operating time was 32 minutes (range 15-55 minutes). One patient suffered an immediate postoperative catheter obstruction that required surgical repositioning. No other technical intra or early postoperative complications related to technique were reported. Mean time to discharge 1.02 +/- 2.2 days. Catheter outflow failure rate was 7.6%. Conversion to haemodialysis due to peritonitis 13%. Peritonitis per patient/year was 0.27. Catheter 6 mo, 1 year and 2 year survival rate was 94%, 87% and 72%. Catheter migration rate was 4%. There was no peritoneal dialysis liquid leakage. CONCLUSIONS: The two ports technique described is an easy and rapid procedure, with few complications and early discharge. Due to its reliability, offers good catheter function outcome.

Colocación de catéter de diálisis peritoneal por la paroscopia: descripción y resultados de una técnica propia de dos puertos / Laparoscopic placement of peritoneal dialysis catheter: description and results of a two-port technique

Objetivo: Estudiar la viabilidad, la eficacia y la seguridad de nuestra técnica de dos puertos de colocación de catéter de diálisis peritoneal por laparoscopia. Material y métodos: Desde enero de 2006 a julio de 2009, 51 pacientes fueron sometidos a colocación de catéter de diálisis peritone alusando una nueva técnica. Todos los procedimientos se completaron laparoscópicamente usando dos puertos de12 mm. Nuestra técnica se basa en la colocación de un catéter de tipo Oreopoulos-Zellerman sobre una guía de Guyon recta con punta a traumática, y garantiza la óptima colocación del catéter. En caso necesario, éste se puede poner de nuevo mediante la recolocación de la guía. El seguimiento medio ha sido de 25 meses. Resultados: Tiempo quirúrgico medio: 32 minutos (rango 15-55 minutos). Un paciente presentó una obstrucción del catéter en el postoperatorio inmediato, que requirió recolocación quirúrgica. No se han producido otras complicaciones técnicas durante la cirugía o el postoperatorio inmediato. Media de tiempo al alta: 1,02 ± 2,2 días. Tasa de obstrucción del catéter: 7,6%. Tasa de conversión ahemodiálisis secundaria a peritonitis: 13%. Episodios de peritonitis por paciente-año: 0,27. Supervivencia del catéter a los 6 meses, un año y 5 años: 94, 87 y 72%,respectivamente. Tasa de migración de catéter: 4%. No se han comentado casos de fístula de líquido peritoneal. Conclusiones: La técnica de dos puertos descrita es un procedimiento sencillo y rápido, con pocas complicaciones y alta hospitalaria inmediata. Debido a su fiabilidad, ofrece buenos resultados en la función del catéter (AU)

Aim: To test the feasibility, efficacy and safety of a new two port laparoscopic technique for dialysis catheter placement. Material and methods: From January 2006to July 2009 51 patients underwent dialysis catheter placing using an original technique. Al l procedures were finished laparoscopically using two 12 mm-sized ports . Our technique bases on placing Oreopoulos -Zel lerman catheter along a straight Guyon´ s guide with atraumatic tip, visually guaranting optimal placement. Catheter can be repositioned if desired by reentering the guide. Median follow-up was 25 months . Results : Mean operating time was 32 minutes ( range15-55 minutes ) . One patient suffered an immediate post operative catheter obstruction that required surgical repositioning. No other technical intra or early postoperative complications related to technique were reported. Mean time to discharge 1.02 ± 2.2 days .Catheter outflow failure rate was 7.6%. Conversion to haemodialysis due to perionitis 13%. Peritonitis per patient/year was 0.27. Catheter 6 mo, 1 year and 2 year survival rate was 94%, 87% and 72%. Catheter migration rate was 4%. There was no peritoneal dialysis liquid leakage. Conclusions : The two ports technique des cribed is an easy and rapid procedure, with few complications and early discharge. Due to its reliability, offers good catheter function outcome (AU)

Comentarios al artículo "Sedación con sevoflurano para resonancia magnética en pediátría: estudio clínico retrospectivo de 5.864 casos" / No disponible

No disponible

Leiomioma vesical / Leiomyoma of the bladder

Presentamos un nuevo caso de leiomioma vesical en una paciente con clínica inespecífica, y en la que las pruebas de imagen preoperatorias no lo orientaron. El diagnóstico definitivo lo dio el estudio anatomopatológico de la pieza quirúrgica (AU)

[The effect of encephalogram bispectral index monitoring during total intravenous anesthesia with propofol in outpatient surgery]. / Repercusión de la monitorización del índice biespectral del electroencefalograma en anestesia intravenosa total con propofol en cirugía sin ingreso.

OBJECTIVE: To assess the effect of monitoring the encephalogram bispectral index (BIS) during outpatient surgery. Outcome measures were amount of propofol administered, awakening and discharge. MATERIAL AND METHODS: Forty consecutive outpatient surgery patients were studied. The patients gave informed consent and received general intravenous anesthesia with propofol administered through a laryngeal mask using a computerized system (Diprifusor(R)). Two groups were formed: in group A, BIS was monitored, although the information was hidden from the anesthesiologists, who used the usual signs (loss of blinking reflex, pupil size and hemodynamic response) to guide anesthesia; in group B the anesthesiologists used BIS monitoring to guide propofol administration. Measurements were blood pressure, heart rate and BIS at six times during the procedure (T1-T6). Other data recorded were age, weight, height, propofol consumption in relation to weight and duration of procedure, consumption of rocuronium and alfentanil, duration of propofol infusion, time from withdrawal of propofol until eye opening, duration of stay in the post-anesthesia intensive care unit and time until total recovery. A questionnaire assessed the presence of intraoperative awareness and degree of satisfaction. The data were analyzed by Student's t and a chi square tests, with statistical significance at p < 0.05. RESULTS: Demographic variables (age, weight and height) were similar, as were duration of propofol infusion, total dose of alfentanil and rocuronium, evolution of blood pressure and heart rate. Statistically significant differences in BIS were observed at two times, T4 and T5; total propofol administered was 32.6% lower in group B; and time until eye opening was significantly shorter in group B. No significant differences were observed for time until full recovery. No instances of intraoperative awareness were reported and satisfaction was high in both groups. CONCLUSION: BIS monitoring allows for propofol titration that leads to a mean reduction of 32.6% in consumption, shortening the time until eye opening without causing intraoperative awareness or reducing patient satisfaction.

Repercusión de la monitorización del índice biespectral del electroencefalograma en anestesia intravenosa total con propofol en cirugía sin ingreso / The effect of encephalogram bispectral index monitoring during total intravenous anesthesia with propofol in outpatient surgery

OBJETIVO. Evaluar la repercusión de la monitorización del índice biespectral del electroencefalograma (BIS) sobre la administración de propofol y sus efectos sobre los parámetros de despertar y alta de la unidad de cirugía sin ingreso.MATERIAL Y MÉTODOS. Con su consentimiento informado, estudiamos a 40 pacientes consecutivos intervenidos en programa de cirugía ambulatoria bajo anestesia general intravenosa con propofol administrado mediante un sistema informatizado (Diprifusor®) y mascarilla laríngea. Se dividieron en dos grupos: grupo A en los que se monitorizó el BIS aunque éste no era visible para el anestesiólogo, que guiaba la anestesia por los signos clínicos habituales (pérdida de reflejo parpebral, tamaño pupilar y respuesta hemodinámica), y grupo B en los que se guió la administración de propofol con la monitorización del BIS. Se midió la presión arterial, la frecuencia cardíaca y el BIS en 6 momentos de la intervención (T1-T6). Registramos la edad, el peso, la talla, el consumo de propofol, rocuronio y alfentanilo en relación con el peso y la duración del procedimiento, la duración de la infusión de propofol, el tiempo desde la parada de la perfusión de propofol hasta apertura ocular, el tiempo de estancia en la unidad e recuperación postanestésica (URPA 1) y el tiempo de recuperación total. Mediante un cuestionario valoramos la presencia de despertar intraoperatorio y el grado de satisfacción. Los datos se analizaron mediante la prueba de la t de Student y el test de la 2, considerando estadísticamente significativa una p < 0,05.RESULTADOS. No hubo diferencias demográficas en cuanto a edad, peso, talla y duración de la perfusión de propofol, ni en el consumo de alfentanilo ni rocuronio. La evolución de la presión arterial y de la frecuencia cardíaca fue similar en ambos grupos. La evolución del BIS evidenció diferencias estadísticamente significativas en dos de los momentos medidos, tiempos T4 y T5. El consumo de propofol fue un 32,6 por ciento inferior en el grupo B. El tiempo de apertura ocular fue inferior en el grupo B de forma estadísticamente significativa, y no hubo diferencias significativas en cuanto al tiempo de recuperación total. No se produjo ningún caso de despertar intraoperatorio, y el grado de satisfacción fue elevado en ambos grupos.CONCLUSIÓN. La monitorización del BIS permite titular la dosis de propofol con un descenso medio del 32,6 por ciento, acortando el tiempo de apertura ocular, sin que se produzca despertar intraoperatorio y sin detrimento en el grado de satisfacción de los pacientes (AU)

No disponible

[Bladder leiomyoma]. / Leiomioma vesical.

A new case of leiomyoma of the bladder is presented in a patient with unspecific symptoms and the preoperatives patterns don't give to a certainty diagnosis. The conclusive diagnosis was obtained with pathoanatomical study of the quirurgic piece.

[Kidney annulment and bladder lithiasis secondary to ureteral catheter]. / Anulación renal y litiasis vesical secundaria a catéter ureteral.

We reported a case of a kidney annulment and bladder stone secondary a foreign body (ureteral stent). We review all the cases of urinary stone secondary a foreign bodies.

Anulación renal y litiasis vesical secundaria a catéter ureteral / Kidney annulment and bladder stone secondary and ureteral stent

Presentamos un caso de anulación renal y litiasis vesical secundaria a la presencia prolongada de un catéter ureteral.Revisamos los casos de litiasis urinaria secundaria a cuerpos extraños (AU)

Carbohydrate content and metabolism as related to maturity and chilling sensitivity of cv. Fortune mandarins.

Fruits of cv. Fortune mandarin were periodically harvested throughout the ripening period to evaluate changes in carbohydrate content and metabolism in flavedo tissue and to determine the potential role of carbohydrates in the tolerance of citrus fruit to chilling injury (CI). Sucrose showed little change in the flavedo during the season, but fructose and glucose increased, in nearly equal amounts, throughout the fall and winter, reaching a maximum in January. Starch levels were less abundant than soluble carbohydrates and rose continuously until March. Sucrose phosphate synthase (SPS; EC 4.1.14) activity decreased from December throughout ripening. Changes in sucrose synthase (SS; EC 2.4.1.13) and acid and alkaline invertase (Inv; EC 3.2.1.26) activities correlated with changes in the reducing sugars, but acid invertase was less active than the other sucrose-metabolizing enzymes. Carbohydrate changes in the flavedo of Fortune mandarins with fruit maturity appear not to be related to the chilling tolerance of fruits during cold storage.

Catalase in the heat-induced chilling tolerance of cold-stored hybrid Fortune mandarin fruits.

Hybrid Fortune mandarins developed chilling injury (CI) upon cold storage, unless the fruits were conditioned at 37 degrees C for 3 days before they were held at low temperature. This heat treatment induced 2.5-, 1.2-, and 1.4-fold increases in the activities of catalase (CAT), ascorbate peroxidase (APX), and superoxide dismutase (SOD), respectively, and reduced the activity of glutathione reductase (GR). The differences in the activities afforded by the heat treatment were, in general, maintained during cold storage. However, SOD levels in nonconditioned Fortune fruits exhibiting CI were similar to those of conditioned fruits stored for 0 or 6 weeks at 2 degrees C. No difference between APX activity in the conditioned and nonconditioned fruits stored for 6 weeks at 2 degrees C was found. The data indicate that CAT may be a major antioxidant enzyme operating in the heat-induced chilling tolerance of cold-stored Fortune mandarin fruits.

Cuerpos lénticos en la llanura bonaerense y su rol en la hidrología global

Los autores del trabajo dan cuenta que los cuerpos lénticos en la Provincia de Bs.As., como consecuencia del ambiente de llanura y su conformación, presentan un significativo desarrollo. A partir de un análisis global en un marco regional, se clasifican los cuerpos en función de aspectos hidráulicos e hidroquímicos. Las experiencias demuestran que el agua de las lagunas proviene fundamentalmente del afloramiento de agua freática, presentando un ritmo de renovabilidad de los caudales muy bajo, lo cual influye en su dinámica ambiental

Sequence analysis of the putative structural genes of hepatitis C virus from Japanese and European origin.

cDNA fragments encoding the putative structural genes of the hepatitis C genome were isolated from a plasma pool of Japanese non-A, non-B hepatitis patients and from sera of individual Spanish patients. From the Japanese plasma pool a series of E1 clones was obtained that showed 88-98% homology among each other, both at the nucleotide and amino acid level. Compared to the sequences published by the Chiron Corporation and Takeuchi et al., the amino acid homology was 75-79% and 91-94%, respectively. Analysis of the core and E2/NS1 genes showed a high conservation of the core sequence and a high sequence variation in the 5' end of the E2/NS1 gene. The E1 gene of one Spanish isolate showed greater homology to the Chiron than to the Japanese sequence. Another Spanish isolate was more homologous to the Japanese sequence indicating that both hepatitis C genotypes are present in Europe. Analysis of the E1 gene of an isolate derived from a single patient with a 5-year interval revealed nine nucleotide and five amino acid changes.

[Supernumerary testis. Communication of a case and review of the literature]. / Testículo supernumerario. Comunicación de un caso y revisión de la literatura.

Polyorchidism is a rare anomaly. Only 72 cases have been reported in the literature. Our case, demonstrated histologically, comprises the 73rd. The results yielded by deferentography and ex situ simultaneous arteriography are presented. The embryological, clinical, pathological and therapeutic aspects reported elsewhere are discussed.

Transvaginal parametrial needle biopsy for detection of postirradiation recurrent cancer of the cervix.

During the 27-year period from 1956 to 1982, transvaginal parametrial needle biopsies were performed on 76 patients clinically suspected of harboring postirradiation recurrent cervical cancer without mucosal lesions suitable for biopsy under direct vision. Needle biopsies indicated cancer in 41 patients, resulting in 20 abdominal explorations. Eleven of these patients underwent total pelvic exenteration. Three patients survived longer than 5 years. Among 35 patients whose biopsies did not suggest cancer, eight proved to be false-negative as demonstrated by later progression of local and systemic disease. The remaining 27 patients in whom biopsies showed negative results were cured by radiation therapy. Bleeding, easily controlled by vaginal packing, occurred in one patient; in another, a pelvic abscess was drained 7 days after the biopsy. The authors conclude that when judiciously performed, transvaginal parametrial needle biopsy has a high diagnostic yield (89%) with minimal morbidity (2.6%). Its application during the careful observation of patients suspected to harbor recurrence may increase the operability rate and may offer selected patients a chance for cure by radical pelvic surgery.

Arginine-vasopressin in essential hypernatremia.

Dynamics of AVP secretion in a 14-year-old girl with essential hypernatremia, psychomotor retardation and optic nerve coloboma, are reported. Basal levels of AVP were similar to those of a control population, but disproportionately low in relation with natremies. Hypertonic saline and hydric restriction did not alter the AVP basal values, which were, instead, stimulated with orthostatism. AVP decreased during a water surcharge, but delayed elimination of water was observed. The existence of a moderate volume deficit, not corrigible with a chronic surcharge of water, together with the reversed diurnal pattern of water excretion and the AVP data, suggest--as a physiopathological basis of the syndrome--a severe anomaly of the osmoreceptors, with alteration of thirst and of the osmodependent AVP responses, so that the AVP secretion was regulated exclusively through volumetric mechanisms.