Physicians versus surgeons. A pilot study on hand dexterity within a controlled population.

INTRODUCTION: Hand dexterity is defined as the innate or acquired capacity of performing any given procedure with one's hands. This study seeks the role of regular hand training on hand dexterity over time. Materials and Methods : Pilot study composed by two independent groups with 28 subjects each (surgeons and physicians), stratified according to gender and age. Measurement of hand dexterity using Lafayette's Purdue Pegboard through the sum of the first three exercises as well as the assembly exercise. No difference was found between groups in regards of gender, age, time of practice and hand size (p = 0.415 ; p = 0.225 ; p = 0.267 ; p = 0.937). Statistical significance was assumed when p < 0.050. RESULTS: Surgeons performed better but a statistically significant difference was not observed both on the -assembly score (p = 0.560) and three tests sum score (p = 0.244). The decay of dexterity over time happened in a homogeneous fashion in the surgeons' arm (p < 0.001 and p = 0.043) but not in the physicians' arm (p = 0.157 and p = 0.098). DISCUSSION: Surgeons seem to perform better than physicians in regards of hand dexterity, although no definitive conclusion was possible given our small sample. It is well known that aging worsens hand -dexterity, but our study suggests it happens much more homogeneously within surgeons.

Clinical experience with linezolid for the treatment of neurosurgical infections.

OBJECTIVES: We sought to evaluate the clinical use of linezolid for the treatment of neurosurgical infections. METHODS: Retrospective observational study of a cohort of hospitalized patients who received linezolid for a culture-positive neurosurgical infection from July 2004 to February 2009 in a tertiary hospital in Spain. RESULTS: Seventeen patients were included in the study. Main comorbidities among these patients included one or more of the following: subarachnoidal or intraventricular hemorrhage (n=8), solid neurological cancer (n=7), corticosteroids(n=9) and hydrocephalus (n=6). Eight patients underwent a craniotomy and fourteen patients had an external ventricular drainage (EVD) as predisposing factors for infection. Meningitis was the most common infection (11; 64.7%), followed by ventriculitis (4; 23.5%) and brain abscesses (2;11.8%). The main causative organisms were coagulase-negative Staphylococcus spp. (13; 76.5%). Linezolid was used as the initial therapy in 8 episodes, after therapy failure in 6 and for other reasons in 3. The oral route was used in 9 (52.9%) episodes; linezolid was initiated orally in 2 cases. The mean duration of treatment was 26.5 days (range 15-58). No adverse events were reported. Sixteen (94.1%) patients were considered cured.There was one recurrence. The mean length of hospital stay was 45.6 (range 15-112) days and the mean duration of follow-up was 7.2 (range 0.4-32) months. No related deaths occurred during active episodes. CONCLUSIONS: Linezolid was mainly indicated in post-neurosurgical EVD-associated infections due to coagulase-negative Staphylococcus spp. It was used as initial therapy in most cases. A high rate of clinical cure was observed and no related adverse events were reported. More than half of the patients were benefited by the advantages of the oral route of administration.

Cirugía conservadora en el tratamiento de los tumores renales de novo en injertos de trasplante renal / Neprhon sparing surgery for renal tumours on kidney transplantation

Introducción: En la actualidad, la cirugía conservadora para el tratamiento del cáncer renal, obtiene unos buenos resultados oncológicos y funcionales, similares a la cirugía radical, con la ventaja de preservar la función renal. Los tumores renales aparecen de novo en el 4,6% de la población transplantada, en comparación con el 3% de la población general, afectando en menos del 10% al injerto renal. Objetivo: El propósito de este trabajo es analizar la experiencia de nuestro centro y realizar revisión de la literatura, en el tratamiento quirúrgico conservador de los tumores renales de novo en injertos de trasplante renal. Material y método: Se realiza un estudio retrospectivo y descriptivo. Hemos analizado 4 pacientes transplantados renales (0,2%), que presentan tumor renal de novo en el injerto renal y tratados mediante cirugía conservadora, desde 1981 hasta agosto de 2008. Se revisaron los resultados funcionales y oncológicos, en comparación con las series publicadas. Se utiliza software informático SPSS 12.0.ResultadosLa mediana de edad al diagnóstico es 46,5 años (42–62). La mediana de tiempo desde el trasplante hasta el diagnóstico es de 92 meses (42–192m). El tamaño mediano ecográfico es de 2,4cm (1,5–3,5) y el tamaño histológico final es 3,0cm (1,7–3,5). Se realizó cirugía conservadora sobre el injerto renal en todos los casos, en 3 de ellos se realizó tumorectomía y una nefrectomía parcial. Solo un paciente (25%) requirió clampaje del pedículo y solo un paciente se transfundió. La estancia mediana hospitalaria es de 6 días. La anatomía patológica muestra carcinoma de células renales en todos los casos, en estadio pT1aN0M0. La función renal no empeoró con respecto al preoperatorio. Todos los pacientes están libres de recidiva con un tiempo mediano de seguimiento de 46,5 meses (15–58). Dos pacientes han fallecido por causas no relacionadas. Conclusiones: La cirugía conservadora renal puede ser una opción de tratamiento para el tratamiento de tumores del injerto. En nuestra experiencia, es un método seguro, en lesiones de pequeño tamaño, que aporta buenos resultados funcionales y oncológicos (AU)

Introduction: Nowadays, nephron sparing surgery for renal carcinoma achieves good oncological results, similar to radical surgery, with the advantage of preserving renal function. Renal cell carcinomas appear de novo in 4.6% of post-transplant patients compared with 3% of tumors in the general population, affecting less than 10% to renal allograft. Objective: The purpose is to analyze our experience and make a literature review about the role of nephron sparing surgery to treat de novo renal tumours in renal grafts. Material and methods: A retrospective and descriptive analysis has been realized, finding four patients who presented with de novo renal tumours over renal graft after kidney transplantation and treated by nephron sparing surgery. A Medline review is done to search similar series published. Oncological and functional results were reviewed and analyzed. We worked with SPSS 12.0 software. Results: Medium age at diagnosis was 46.5 y (42–62). Medium size was 2.4cm. (1.5–3.5) and final histology showed medium tumours size of 3.0cm. (1.7–3.5). Medium hospital stay was 6.0d. Medium time from transplantation to diagnosis was 92 months (42–192). NSS was done in all cases, in 3 cases tumorectomy and one partial nephrectomy. Transfusion was only needed in one case. All cases had pT1aN0M0 RCC histology exam. Renal function did not change from preoperative. All patients are free of progression with a medium follow-up of 46.5 months (15–58). Conclusions: NSS could be an option to treat graft tumours in selected cases, preserving renal function. In our experience, is a safe and efficient treatment in patients with small de novo renal tumours over renal graft (AU)

[Neprhon sparing surgery for renal tumours on kidney transplantation]. / Cirugía conservadora en el tratamiento de los tumores renales de novo en injertos de trasplante renal.

INTRODUCTION: Nowadays, nephron sparing surgery for renal carcinoma achieves good oncological results, similar to radical surgery, with the advantage of preserving renal function. Renal cell carcinomas appear de novo in 4.6% of post-transplant patients compared with 3% of tumors in the general population, affecting less than 10% to renal allograft. OBJECTIVE: The purpose is to analyze our experience and make a literature review about the role of nephron sparing surgery to treat de novo renal tumours in renal grafts. MATERIAL AND METHODS: A retrospective and descriptive analysis has been realized, finding four patients who presented with de novo renal tumours over renal graft after kidney transplantation and treated by nephron sparing surgery. A Medline review is done to search similar series published. Oncological and functional results were reviewed and analyzed. We worked with SPSS 12.0 software. RESULTS: Medium age at diagnosis was 46.5 y (42-62). Medium size was 2.4cm. (1.5-3.5) and final histology showed medium tumours size of 3.0cm. (1.7-3.5). Medium hospital stay was 6.0d. Medium time from transplantation to diagnosis was 92 months (42-192). NSS was done in all cases, in 3 cases tumorectomy and one partial nephrectomy. Transfusion was only needed in one case. All cases had pT1aN0M0 RCC histology exam. Renal function did not change from preoperative. All patients are free of progression with a medium follow-up of 46.5 months (15-58). CONCLUSIONS: NSS could be an option to treat graft tumours in selected cases, preserving renal function. In our experience, is a safe and efficient treatment in patients with small de novo renal tumours over renal graft.

Fiebre por mordedura de rata. Un caso en España con lesiones cutáneas características / Rat-bite fever: A case in Spain with skin lesions

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Dosimetric audits of photon beams in radiation therapy centres in Rio de Janeiro, Brazil.

Data related to 11 y of high-energy photon radiotherapy beam dosimetry are presented and analysed. Dosimetric evaluations were carried out using water phantoms and thimble ionisation chambers and are part of the radiation protection regulatory licensing process for medicine facilities of Brazilian government. Measurements were done at reference conditions for a standard absorbed dose of 100 cGy [cGy (=1 rad)]. The absolute per cent deviation between the measured and presumed delivered doses should not exceed the tolerance level of +/-3%. The first dosimetry survey from 1996 to 1998 showed a situation that was an object of concern. Deviations of 22 and 18.7% could be measured, although small deviations were also obtained. After 1998, the improvement in dosimetry quality control by the radiotherapy centres became clear, with most of the deviations situated within the +/-3% range. The decrease in the measured deviations presents the effective success of the Institute of Radiation Protection and Dosimetry audit programme for the improvement in the control of radiotherapy photon beams in Rio de Janeiro. Also, it is possible to recommend to Brazilian regulatory organisation a decrease in the tolerance level for dosimetric deviations in order to achieve a more precise dose delivered to patients in radiotherapy centres.

Divertículo de uretra habitado por litiasis / Diverticulum of the urethra occupied by lithiasis

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Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo mediante cabestrillo suburetral SPARC. Análisis de nuestra experiencia / Stress urinary incontinence surgical treatment with suburethral suprapubic sparc sling

Introducción: La incontinencia urinaria de esfuerzo (IUE) presenta una gran morbilidad y una elevada incidencia. Existen múltiples técnicas quirúrgicas descritas para el tratamiento de la misma, con diversos resultados. Los cabestrillos suburetrales se han establecido en los últimos años como un método simple y poco invasivo para el tratamiento de la incontinencia urinaria de esfuerzo. Material y Método: Analizamos retrospectivamente nuestra serie de 86 pacientes diagnosticadas de IUE, intervenidas, entre Octubre de 2001 y Diciembre de 2005, mediante un cabestrillo suburetral suprapúbico (SPARC(C)). Resultados: La media de edad es de 58,7 años (39-80). La estancia media hospitalaria es de 2,43 días (1-8) y la duración media de sonda de 1,52 días (1-10). En el 14,5% de los casos, se realizó cirugía asociada, siendo la más frecuente, la colpoperineoplastia anterior (10,7 %). Las complicaciones son poco frecuentes; perforación vesical (5,8%), RAO antes del alta (7%), ITU (15,3%), RAO crónica (3,5%). En el 3,5% de las mujeres, se realizó lisis del cabestrillo, por retención crónica. El seguimiento medio es de 10,14 meses, encontrándose un 71,4% de continencia total. Un 26,2% de las pacientes presentaron síntomas de hiperactividad de novo, con problemas de incontinencia en el 54,5% de estas. (p<0,002; OR 5.0 (IC 95% 1,75-14,28). Conclusiones: El SPARC© es un método sencillo, con un tiempo hospitalario corto y una rápida reincorporación a la vida social. Los resultados pueden ser valorados rápidamente y con una tasa elevada de éxito. La aparición de urgencia de novo es elevada y empeora los resultados funcionales. Es necesario un mayor seguimiento para valorar resultados funcionales a largo plazo

Introduction: Stress urinary incontinence (SUI) has a high incidence and important morbidity. Multiple surgical techniques have been described to treat it, with despair results. Suburethral slings have become, in recent years, a simpler and less invasive method to treat SUI surgically. Material and method: The purpose of this paper is to review, retrospectively, 86 patients treated at our institution, from 10/01 to 12/05 of SUI, with a suprapubic suburethral sling (SPARC). Results: Medium (range) age is 58.7 (39-80), hospital stay was 2.43 d (1-8) and catheter was removed 1.52 d (1-10). 14.5% of patients underwent other vaginal surgeries at same time, most frequently anterior colpoperineoplasty (10.7%). Complications are not very frequent; bladder perforation (5.8%), acute urinary retention (7%), chronic urinary retention (3.5%) and UTI (15.3%). Sling release was performed in 3.5% of women with chronic urinary retention. Total continence was found in 71.4% of patients with 10.1 months medium follow up (1-32). De novo urge symptoms were found in 26.2% of women, with urge incontinence in 54.5% of them. (p < 0,002; OR 5.0 (IC 95% 1.75-14.28). Conclusions: Suprapubic suburethral SPARC sling is a simple method, with few complications and fast social recovery. Outcome can be measured soon, with a high continence rate. De novo urge symptoms are high and they worsen functional results. It is necessary longer follow-up to evaluate long term outcomes

Atrapamiento peneano por anillos metálicos / Penile entrapment by metallic rings

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Masa pélvica y anorquia bilateral / Pelvic mass and bilateral anorchia

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[Vesicoureteral reflux in spinal cord injured patients. Treatment results and statistical analysis]. / Reflujo vesicoureteral en pacientes lesionados medulares. Analisis estadistico de resultados en el tratamiento.

INTRODUCTION: VUR in spinal cord injured patients is cause of important morbidity and mortality. The aim of this paper is to make a statistical, retrospective and descriptive study to analyze VUR treatment results, in neurogenic bladder SCI patients. MATERIAL AND METHOD: We study 40 patients (80 renal units) with VUR in neurogenic bladders and SCI, between March, 1990 and November, 2004. Median age is 43.05 y (9-76). 77.5% of patients are males (3.4:1). Time from injury to VUR is 24.7m (0.2-87). Median follow up is 8.23a (0.5-29). Traumatic lesions are most frequent (70%). Median bladder capacity is 244.9 ml (43-555) and median bladder compliance is 16.12 ml/cm H2O (0.3-61.6). Detrusor overactivity is found in 72.2% and detrusor-sphincter dyssynergia in 71.8%. Initial conservative treatment is done with indwelling catheter and anticholinergics RESULTS: Complete remission was found in 57.5% of RU, descending VUR a 23.7% (66.2% previously to 42.5% after; p<0.02), and predominant in unilateral reflux. Partial response was found in 3.8%, progression in 12.5% and recidiva post CR in 10.9%. Younger patients have better remission rates (39.4 to 47.6 y; p=0.04). Urodinamycs variables don't found any significant differences in treatment results. Endoscopic treatment with bulking agents gets a good response rate (56.3%) (p=0.18). CONCLUSIONS: Initial conservative treatment gets a 23.7% reduction of VUR, especially in men, young and unilateral reflux patients. Anyhow, we observe some progression and recidiva. Detrusor overactivity and detrusor-sphincter dyssynergia didn't influence in treatment results, but they are found in all patients with recidiva. With longer reflux evolution, we observe better responses, but also a higher recidiva rate (p=0.007). Endoscopic bulky injection techniques found out a good response rate (56.3%), also in patients with recidiva after conservative treatment.

Reflujo vesicoureteral en pacientes lesionados medulares. Analisis estadístico de resultados en el tratamiento / Vesicoureteral reflux in spinal cord injured patients. Treatment results and statistical analysis

Introducción: El RVU en pacientes con lesión medular es una causa importante de morbilidad y mortalidad. El objetivo de este trabajo, es realizar un estudio retrospectivo, descriptivo y estadístico que analiza los resultados en el tratamiento del reflujo vesicoureteral, en los pacientes con vejiga neurógena establecida. Material y método: Se estudian 40 pacientes con RVU, secundario a vejiga neurógena por lesión medular, entre marzo/90 y noviembre/04. Se observa RVU en el 66,2% de las UR. La edad media es 43,05a (9-76). El 77,5% son hombres (3,4:1). La evolución desde la lesión medular hasta el diagnóstico del RVU de 24,7 meses (0,2-87m). El tiempo de seguimiento es de 8,23a (0,5- 29). Etiología traumática en el 70%. La capacidad vesical media es de 244,9 ml (43-555ml), la compliance vesical media es de 16,12 ml/cm. H20 (0,3-61,6). La hiperactividad del detrusor se aprecia en 72,2% y la disinergia vesico-esfinteriana externa en 71,8%. El tratamiento inicial es conservador con sondaje vesical y terapia anticolinérgica. Resultados: Curación completa del RVU en el 57,5%, se reduce un 23,7% (66,2% frente 42,5%, p<0,02); predominantes en reflujos unilaterales. Mejoría parcial, con reducción del grado previo en 3,8%. Progresión a grados superiores en 12,5%. Recidivas post-curación completa en 10,9% Los pacientes más jóvenes curan mejor (39,4 frente a 47,6 años, p=0,04). Al analizar las variables urodinámicas, no encontramos diferencias estadísticas. El tratamiento endoscópico consigue una curación del 56.3% (p=0,18). Conclusiones: Con el manejo conservador inicial, se consigue una reducción del reflujo vesicoureteral en el 23,7%, preferentemente en aquellos pacientes con reflujo unilateral, jóvenes (p=0,04) y varones. La presencia o ausencia de hiperactividad o disinergia, no empeora o mejora los resultados, sin embargo se asocia con recidivas. A mayor tiempo de evolución, mejores tasas de curación, pero también mayores recidivas (p=0,007). El tratamiento endoscópico con sustancias abultantes, obtiene una buena tasa de curación (56,3%), incluso en pacientes recidivados después del tratamiento conservador

Introduction: VUR in spinal cord injured patients is cause of important morbidity and mortality. The aim of this paper is to make a statistical, retrospective and descriptive study to analyze VUR treatment results, in neurogenic bladder SCI patients. Material and method: We study 40 patients (80 renal units) with VUR in neurogenic bladders and SCI, between March, 1990 and November, 2004. Median age is 43.05 y (9-76). 77.5% of patients are males (3.4:1). Time from injury to VUR is 24.7m (0.2-87). Median follow up is 8.23a (0.5-29). Traumatic lesions are most frequent (70%). Median bladder capacity is 244.9 ml (43-555) and median bladder compliance is 16.12 ml/cm H20 (0.3-61.6). Detrusor overactivity is found in 72.2% and detrusor-sphincter dyssynergia in 71.8%. Initial conservative treatment is done with indwelling catheter and anticholinergics Results: Complete remission was found in 57.5% of RU, descending VUR a 23.7% (66.2% previously to 42.5% after; p<0.02), and predominant in unilateral reflux. Partial response was found in 3.8%, progression in 12.5% and recidiva post CR in 10.9%. Younger patients have better remission rates (39.4 to 47.6 y; p=0.04). Urodinamycs variables don’t found any significant differences in treatment results. Endoscopic treatment with bulking agents gets a good response rate (56.3%) (p=0.18). Conclusions: Initial conservative treatment gets a 23.7% reduction of VUR, especially in men, young and unilateral reflux patients. Anyhow, we observe some progression and recidiva. Detrusor overactivity and detrusor-sphincter dyssynergia didn’t influence in treatment results, but they are found in all patients with recidiva. With longer reflux evolution, we observe better responses, but also a higher recidiva rate (p=0.007). Endoscopic bulky injection techniques found out a good response rate (56.3%), also in patients with recidiva after conservative treatment

Long-term follow-up study of intraurethral stents in spinal cord injured patients with detrusor-sphincter dyssynergia.

STUDY DESIGN: Retrospective study. OBJECTIVES: To assess in the long-term clinical and urodynamic results of intraurethral stents in a group of patients with spinal cord injury. SETTING: Spinal Cord Injury Unit, Juan Canalejo Hospital, A Coruña, Spain. METHODS: Forty-seven consecutive male patients were studied from 1993 to 2002. All of them suffered from hyperreflexia with detrusor-sphincter dyssynergia (DSD) owing to spinal cord injury, and were treated by means of the placement of an intraurethral stent at the external sphincter. RESULTS: After surgery, significant decreases in all the parameters studied were observed. The number of patients with symptoms of urinary tract infection decreased by 25% (P<0.031). Post-void residual urine volume experienced an average decrease of 224.3 cm(3) (P=0.001). Episodes of dysreflexia decreased from 35.1 to 16.2% (P=0.039). The urodynamic study showed an average reduction of 44.36 cm H(2)O in the maximum detrusor pressure (P<0.0001). Complications in the upper urinary tract descended from 46.8 to 23.4% after placing the stent (P=0.013). The most frequent stent complication was displacement, followed by stenosis, lithiasis and intraprosthetic calcification. In all, 8.5% required the stent removal. CONCLUSIONS: Intraurethral stent is a good choice for the long-term management of DSD in spinal cord-injured patients, even in those who had been previously submitted to prior sphincterotomy. It has the advantage of being a potentially reversible procedure, so patients prefer it to more invasive therapies such as sphincterotomy.

[Stress urinary incontinence surgical treatment with suburethral suprapubic SPARC sling]. / Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo mediante cabestrillo suburetral SPARC. Análisis de nuestra experiencia.

INTRODUCTION: Stress urinary incontinence (SUI) has a high incidence and important morbidity. Multiple surgical techniques have been described to treat it, with despair results. Suburethral slings have become, in recent years, a simpler and less invasive method to treat SUI surgically. MATERIAL AND METHOD: The purpose of this paper is to review, retrospectively, 86 patients treated at our institution, from 10/01 to 12/05 of SUI, with a suprapubic suburethral sling (SPARC). RESULTS: Medium (range) age is 58.7 (39-80), hospital stay was 2.43 d (1-8) and catheter was removed 1.52 d (1-10). 14.5% of patients underwent other vaginal surgeries at same time, most frequently anterior colpoperineoplasty (10.7%). Complications are not very frequent; bladder perforation (5.8%), acute urinary retention (7%), chronic urinary retention (3.5%) and UTI (15.3%). Sling release was performed in 3.5% of women with chronic urinary retention. Total continence was found in 71.4% of patients with 10.1 months medium follow up (1-32). De novo urge symptoms were found in 26.2% of women, with urge incontinence in 54.5% of them. (p < 0.002; OR 5.0 (IC 95% 1.75-14.28). CONCLUSIONS: Suprapubic suburethral SPARC sling is a simple method, with few complications and fast social recovery. Outcome can be measured soon, with a high continence rate. De novo urge symptoms are high and they worsen functional results. It is necessary longer follow-up to evaluate long term outcomes.