Microparticle-embedded fibroin/alginate beads for prolonged local release of simvastatin hydroxyacid to mesenchymal stem cells.

In the present work, we propose silk fibroin/alginate (SF/Alg) beads embedding simvastatin-loaded biodegradable microparticles as a versatile platform capable of tuning SVA release and in so doing osteogenic effects. In a first part of the study, microparticles of poly(lactic-co-glycolic) acid incorporating simvastatin either as lactone (SVL) or as hydroxyacid form (SVA) were prepared by spray-drying. While SVA-loaded microparticles released the drug in three days, long-term release of SVA could be obtained from SVL-loaded microparticles. In this latter case, SVL was promptly transformed to the osteogenic active SVA during release. When tested on mesenchymal stem cells, a time- and dose-dependent effect of SVL-loaded microparticles on cell proliferation and alkaline phosphatase (ALP) activity was found. Thereafter, SVL-loaded microparticles were embedded in SF/Alg beads to limit the initial simvastatin burst and to achieve easier implantation as well. Microparticle-embedded beads showed no cytotoxicity while ALP activity increased. If correctly exploited, the developed system may be suitable as osteogenic polymer scaffolds releasing correct amount of the drug locally for long time-frames.

Metástasis deltoidea de un carcinoma papilar seroso ovárico / Deltoid metastasis of an ovarian papillary serous carcinoma

Las metástasis intramusculares son un hallazgo muy infrecuente, suponen aproximadamente el 1% de las metástasis, siendo más frecuente a nivel de musculatura abdominal y miembros inferiores. Esta baja incidencia es debido a que existen diferentes mecanismos de resistencia al desarrollo de las mismas, además existe un infradiagnóstico de las mismas por su baja sintomatología

Intramuscular metastases are rarely diagnosed, it about 1% all kind of metastases, and frequently are localized in the abdominal muscles and lower extremity. Low incidence is due to different resistance mechanisms to its develop, thus an underdiagnosis because its low symptomatology

[Key aspects in interpreting clinical trials in radiology]. / El ensayo clínico en Radiología: claves para su interpretación.

A clinical trial is an experimental study to evaluate the efficacy and safety of a treatment or diagnostic technique in human beings. To ensure the methodological quality of a clinical trial and the validity of its results, various checklists have been elaborated to identify biases that could invalidate its conclusions. This article focuses on the points we need to consider in the critical evaluation of a clinical trial. We can usually find this information in the "materials and methods" and "results" sections of articles. Randomization, follow-up (or analysis of losses), blinding, and equivalence between groups (apart from the intervention itself) are some key aspects related to design. In the "results" section, we need to consider what measures of clinical efficacy were used (relative risk, odds ratio, or number needed to treat, among others) and the precision of the results (confidence intervals). Once we have confirmed that the clinical trial fulfills these criteria, we need to determine whether the results can be applied in our environment and whether the benefits obtained justify the risks and costs involved.

Experiencia con un formato simplificado de la herramienta de ayuda en la toma de decisiones Adjuvant Online en pacientes con cáncer de mama / Experience with a simplified format of decision making tool adjuvant Online in breast cancer patients

Fundamento. Adjuvant. Online calcula el riesgo de recidiva y muerte a 10 años y proporciona estimaciones del beneficio del tratamiento adyuvante en pacientes con cáncer de mama. Testamos su aplicabilidad y analizamos únicamente estimaciones de mortalidad. Método. Presentamos las estimaciones de 66 pacientes intervenidas de cáncer de mama unilateral y unicéntrico, sin enfermedad residual ni metástasis. Las variables analizadas fueron edad, comorbilidad, receptores de estrógenos, grado histológico, tamaño tumoral, ganglios metastásicos, tipo de tratamiento hormonal y de quimioterapia. Resultados. La estimación de la mediana de supervivencia fue del 77%, de mortalidad por cáncer fue del 18% y por otras causas fue del 5%. La media de reducción absoluta del riesgo (RAR) de mortalidad con tratamiento hormonal fue del 4%, con quimioterapia fue del 4,5% y con tratamiento combinado fue del 7%. Resultados. Todas las pacientes con algún beneficio decidieron recibir tratamiento hormonal. Cuarenta y tres pacientes (65%) decidieron recibir quimioterapia y 23 pacientes (35%) decidieron no recibirla. La media de reducción del riesgo con quimioterapia fue del 2% en quien decidió no recibir quimioterapia y fue del 8% en quien decidió recibirla. Existe asociación entre la decisión de quimioterapia y la estimación del riesgo de mortalidad por cáncer (p=0,0001), del riesgo de mortalidad por otras causas (p=0,038) y de la RAR (p=0,0001). El 6% de las pacientes con RAR del 1%, el 50% de las que tenían RAR entre el 2–5%, y el 61,8% con RAR entre el 6–10% eligieron la quimioterapia. Conclusiones. Todas las mujeres optan por el tratamiento hormonal independientemente del beneficio. Las razones para elegir la quimioterapia fueron el propio pronóstico vital y la magnitud del beneficio. Algunas pacientes deciden elegir quimioterapia con beneficios mínimos(AU)

Background. Adjuvant. Online estimates 10-year recurrence and mortality outcomes for breast cancer patients and predicts the effect of each type of treatment. Our purpose was to test the applicability by only analysing mortality estimations. Method. We present estimations of 66 women with definitive surgery and axillary staging for unilateral, unicentric, invasive adenocarcinoma, without metastatic or residual disease. Age, co-morbidity, estrogen receptor status, histological grade, tumor size, number of positive nodes, and hormone therapy or chemotherapy option, were the variables required. Results. Median of survival estimations was 77%, cancer mortality 18% and mortality for other reasons 5%. The average of absolute risk reduction (ARR) with hormone therapy was 4%, with chemotherapy 4.5% and with combined treatment 7%. Results. All the patients with some benefit decided to receive hormone therapy. Forty-three patients (65%) decided to receive chemotherapy and 23 (35%) did not. The average risk reduction with chemotherapy was 2% in those who decided not to receive chemotherapy and 8% in those who decided to receive it. There was an association between a chemotherapy decision and the estimation of the risk of breast cancer mortality (P=0.0001), risk of mortality for other reasons (P=0.038), and the ARR (P=0.0001). There were 6% of the patients with an ARR of 1%, 50% between 2–5% and 61.8% between 6–10%, who chose chemotherapy. Conclusions. All women opted for hormone therapy regardless of benefit. The reasons for choosing chemotherapy were the prognosis itself and the magnitude of benefit. Some patients decided to choose chemotherapy even when the benefit was minimal(AU)

[Experience with a simplified format of decision making tool adjuvant! Online in breast cancer patients]. / Experiencia con un formato simplificado de la herramienta de ayuda en la toma de decisiones Adjuvant! Online en pacientes con cáncer de mama.

BACKGROUND: Adjuvant! Online estimates 10-year recurrence and mortality outcomes for breast cancer patients and predicts the effect of each type of treatment. Our purpose was to test the applicability by only analysing mortality estimations. METHOD: We present estimations of 66 women with definitive surgery and axillary staging for unilateral, unicentric, invasive adenocarcinoma, without metastatic or residual disease. Age, co-morbidity, estrogen receptor status, histological grade, tumor size, number of positive nodes, and hormone therapy or chemotherapy option, were the variables required. RESULTS: Median of survival estimations was 77%, cancer mortality 18% and mortality for other reasons 5%. The average of absolute risk reduction (ARR) with hormone therapy was 4%, with chemotherapy 4.5% and with combined treatment 7%. All the patients with some benefit decided to receive hormone therapy. Forty-three patients (65%) decided to receive chemotherapy and 23 (35%) did not. The average risk reduction with chemotherapy was 2% in those who decided not to receive chemotherapy and 8% in those who decided to receive it. There was an association between a chemotherapy decision and the estimation of the risk of breast cancer mortality (P=0.0001), risk of mortality for other reasons (P=0.038), and the ARR (P=0.0001). There were 6% of the patients with an ARR of 1%, 50% between 2-5% and 61.8% between 6-10%, who chose chemotherapy. CONCLUSIONS: All women opted for hormone therapy regardless of benefit. The reasons for choosing chemotherapy were the prognosis itself and the magnitude of benefit. Some patients decided to choose chemotherapy even when the benefit was minimal.

[Retroperitoneoscopic assisted pyeloplasty for ureteropelvic junction obstruction in children]. / Pieloplastia asistida por retroperitoneoscopia: nuestra experiencia en 30 pacientes.

OBJECTIVES: Description of the retroperitoneoscopic approach in the conventional pyeloplasty for ureteropelvic junction obstruction in children. MATERIAL AND METHODS: From 1998 pyeloplasty assisted by retroperitoneoscopic approach (PARA) was performed in 30 patients. TECHNIQUE: Position in latero-dorsal decubitus and incision of 1 cm in angle costolumbar. We made retroperitoneoscopic space by ball dissection technique and 11 mm Hg pressure. The ureteropelvic junction was extracted through the incision of the port. The UPJ was resected in all patients and Anderson-Hynes pyeloplasty with double PDS 6/0 continuous sutures was performed. In all patients a drainage type Penrose in perirenal space was used. In the last 18 patients a 4F double-J stent was placed. The mean follow-up time was 42 months (range between 6 and 84 months). Operative time, hospital stay, handling of postoperative pain and the postoperative studies have been revised. RESULTS: In all the cases the retroperitoneoscopic approach was good for the identification and dissection of the ureteropelvic junction facilitating the extraction and reconstruction (pyeloplasty) through the mini-incision of the entrance port. The mean operative time was 90 min. (range between 65 and 128 min). We highlight the absence of intraoperative complications. The only postoperative complication has been a pyohydronephrosis in a patient not having internal drainage that was solved by percutaneous pyelostomy and didn't need reintervention. The postoperative handling of the pain was good by means of caudal locorregional anesthesia or by infiltration of the wound with local anesthesic and a dose of Ibuprofeno previous to leave the hospital. The mean hospital stay was 2 days (1-3 days) excluding the complicated case. Postoperative diuretic renograms at the 6 and 18 have shown absence of obstruction in all cases. In the long term follow-up, in 1 case nephrectomy was performed. CONCLUSIONS: The PARA for UPJ obstruction is a safe and effective procedure with the advantage of a minimal invasive approach that facilitates the reconstruction of the ureteropielic junction. Reduces operative time and hospital stay, with appropriate postoperative results. In our experience PARA constitutes an alternative to the conventional pyeloplasty and laparoscopic pyeloplasty in the pediatric age.

Pieloplastia asistida por retroperitoneoscopia: nuestra experiencia en 30 pacientes / Retropenitoneoscopic assisted pyeloplasty for ureteropelvic junction obstruction in children

Objetivos. Descripción del abordaje retroperitoneoscópico en la pieloplastia convencional para la obstrucción de la unión pieloureteral en niños. Material y métodos. Desde 1998 hemos realizado pieloplastia asistida por retroperitoneoscopia (PAR) en 30 pacientes. Técnica. Posición en decúbito lateroposterior e incisión de 1 cm en ángulo costolumbar. Creación de espacio retroperitoneoscópico con balón de disección neumática y mantenimiento del mismo mediante retroneumoperitoneo de hasta 11 mmHg. Exteriorización de la unión pieloureteral a través de la incisión del puerto de entrada. Ureteropieloplastia mediante neoanastomosis con doble sutura continua de PDS 6/0 y magnificación. Drenaje tipo Penrose en lecho peri renal. En los últimos 18 pacientes se tutorizó la neounión mediante drenaje interno doble J. El seguimiento medio ha sido de 42 meses (rango entre 6 y 84 meses). Se ha revisado: el tiempo operatorio, la estancia hospitalaria, el manejo de dolor postoperatorio y los estudios postoperatorios de seguimiento renográfico. Resultados. En todos los casos, el abordaje retroperitoneoscópico fue óptimo para la identificación y disección de la unión pieloureteral facilitando la extracción y reconstrucción (pieloplastia) a través de la miniincisión del puerto de entrada. El tiempo medio de la cirugía ha sido de 90 min (rango entre 65 y 128 min). Destacamos la ausencia de complicaciones intraoperatorias. La única complicación postoperatoria de la serie ha sido un episodio de pielohidronefrosis, en un paciente no portador de drenaje interno, que se solucionó mediante pielostomía percutánea y que no precisó reintervención. El manejo postoperatorio del dolor fue óptimo mediante anestesia locorregional caudal o infiltración de la herida quirúrgica con anestésico local y una dosis de ibuprofeno oral intrahospitalario. La estancia media ha sido de 2 días (rango entre 1 y 3 días) excluyendo el caso complicado. Los controles postoperatorios mediante renograma diurético a los 6 y 18 meses de la cirugía han mostrado ausencia de obstrucción en todos los casos. En el seguimiento a largo plazo fue necesario realizar nefrectomía en 1 caso. Conclusiones. La pieloplastia asistida por retroperitoneoscopia ha demostrado ser una técnica de abordaje mínimamente invasiva que facilita la cirugía reconstructiva de la unión pieloureteral, que reduce el tiempo operatorio y la estancia hospitalaria, con resultados postoperatorios adecuados. La PAR constituye una alternativa a la pieloplastia convencional y a la pieloplastia laparoscópica en el tratamiento de la hidronefrosis en la edad pediátrica (AU)

OBJECTIVES: Description of the retroperitoneoscopic approach in the conventional pyeloplasty for ureteropelvic junction obstruction in children. MATERIAL AND METHODS: From 1998 pyeloplasty assisted by retroperitoneoscopic approach (PARA) was performed in 30 patients. Technique: Position in latero-dorsal decubitus and incision of 1 cm in angle costolumbar. We made retroperitoneoscopic space by ball dissection technique and 11 mm Hg pressure. The ureteropelvic junction was extracted through the incision of the port. The UPJ was resected in all patients and Anderson-Hynes pyeloplasty with double PDS 6/0 continuous sutures was performed. In all patients a drainage type Penrose in perirenal space was used. In the last 18 patients a 4F double-J stent was placed. The mean follow-up time was 42 months (range between 6 and 84 months). Operative time, hospital stay, handling of postoperative pain and the postoperative studies have been revised. RESULTS: In all the cases the retroperitoneoscopic approach was good for the identification and dissection of the ureteropelvic junction facilitating the extraction and reconstruction (pyeloplasty) through the mini-incision of the entrance port. The mean operative time was 90 min. (range between 65 and 128 min). We highlight the absence of intraoperative complications. The only postoperative complication has been a pyohydronephrosis in a patient not having internal drainage that was solved by percutaneous pyelostomy and didn't need reintervention. The postoperative handling of the pain was good by means of caudal locorregional anesthesia or by infiltration of the wound with local anesthesic and a dose of Ibuprofeno previous to leave the hospital. The mean hospital stay was 2 days (1-3 days) excluding the complicated case. Postoperative diuretic renograms at the 6 and 18 have shown absence of obstruction in all cases. In the long term follow-up, in 1 case nephrectomy was performed. CONCLUSIONS: The PARA for UPJ obstruction is a safe and effective procedure with the advantage of a minimal invasive approach that facilitates the reconstruction of the ureteropielic junction. Reduces operative time and hospital stay, with appropriate postoperative results. In our experience PARA constitutes an alternative to the conventional pyeloplasty and laparoscopic pyeloplasty in the pediatric age (AU)

Lipoestructura según técnica de Coleman. Experiencia personal / Lipostructure with Coleman technique. Personal experience

La lipoestructura está basada en la modificación tridimensional permanente de la anatomía, mediante el relleno con el propio tejido graso del paciente, previamente purificado. La importancia de la técnica consiste en rellenar el tejido desaparecido y atrófico y en que ofrece resultados predecibles, permanentes y seguros. Hay que familiarizarse con el procedimiento no sólo para aplicarlo a procedimientos de Cirugía Estética, sino por su utilidad en reconstrucciones dentro del capítulo de la Cirugía Reparadora. Empleamos la técnica desde el año 2000, con un seguimiento máximo de tres años. Durante este periodo hemos realizado seis lipoestructuras faciales; en dos ocasiones asociadas a estiramientos, con muy buenos resultados y gran satisfacción por parte de las pacientes; de igual modo, aplicándola técnica a problemas de reparación facial, hemos realizado dos procedimientos, en una paciente que presentaba atrofiahemifacial y en otra con un Síndrome de primer y segundo arco branquial, con muy buenos resultados a largo plazo. También hemos tratado problemas de reparación corporal en cinco pacientes con secuelas de poliomielitis, zonas deprimidas en glúteos, cicatrices en la cara, secuelas de liposucción en muslos y secuelas iatrogénicas de mastectomía en un paciente con ginecomastia. Los resultados nos han animado air ampliando las indicaciones (AU)

Lipostructure is a technique based on three-dimensional change of the anatomy, injecting fat autografting previously centrifugated. The innovation of this technique is refill atrophy and disappeared tissues with permanent, reliable and predictable results. Learn the correct technique is useful to correct as Aesthetic as Reconstructive defects. We have applied this procedure since 2000, with postoperative results to three years. In six face lipoinjections, two of them as adjunct procedure of lifting, very good aesthetic improvement for patient and surgeon was obtained. In the same way two patients with hemifacial atrophy and first and second arch brachial Syndrome have been benefited from fat autografting injections. Related to reconstructive problems we have repaired five patients with poliomyelitis sequelae, depressed gluteus tissues, midfacial scar, calf liposuction iatrognic sequelae, and mastectomy secuelae in a man with ginecomasty. Excellent results encourage us to increment indications (AU)

[Treatment of infantile varicocele with percutaneous embolization]. / Tratamiento del varicocele infantil mediante embolización percutánea.

Nine boys, aged 11-13 years with left varicocele grade II or III, were treated by percutaneous embolization of internal spermatic vein at the General Yagüe hospital in the last four years. The procedure was performed under local anesthesia. Percutaneous selective retrograde left spermatic venography was done via the right transfemoral vein. For embolization, sclerosing agents were used in eight cases and coil in one. Follow-up ranged from six months to four years. The control clinical examination and ultrasonographic evaluation showed treatment was successful in eight cases (89%) and persistence of a left varicocele in one case (11%). No serious complications were observed and the mean duration of hospital stay was 1.6 days. The safety, efficacy and feasibility of percutaneous embolization are discussed.

[Congenital short urethra: surgical treatment]. / Uretra corta congénita: tratamiento quirúrgico.

Presentation of 6 cases of congenitally short urethra seen in our Unit. The rarity of such malformation, as well as the difficulties to arrive to a presurgical diagnosis are emphasized. Also, review of surgical techniques described in the literature. Contribution of our experience in the use of the urethra's dissecting and elevating technique. We considered this the choice procedure except in extreme cases due to the good results obtained, fewer technical difficulties and lower risk of complications.

[Response of micropenis to topical testosterone and gonadotrophines. A comparative study (author's transl)]. / Estudio comparativo del desarrollo del pene en niños portadores de hipospadias por medio de testosterona y gonadotropina coriónica.

Hypoplasia of penis which is frequently associated with hipospadias is important when a surgical treatment of this malformation is to undertaken. The decision to increase the dimensions of the penis before surgery by means of hormone treatments is based on good surgical results obtained in very young patients with hypoplasia. The authors have conducted a study involving 76 boys with hipospadias over a period of four years. One group of 37 boys was treated with corionic gonadotrophines by injection during a period of eight weeks. The second group of 39 boys was treated with testosterone cream (2%) topically during one month. Measurements were taken before and after the treatments using four parameters, and the boys were separated according to age. The results showed a more favorable response to testosterone cream in comparison to the injections of corionic gonadotrophines.

Congenital short urethra.

A surgical technique is described for the short urethra. The malformation is also described and differentiated from penile curvature of cutaneous origin. The urethroplasty involves division of the short urethra and the design of an island flap using penile skin formed into a tube over a sound. The reconstructed segment is placed between two divided segments of the original short urethra and restores its natural length. Complications and results are discussed. We have also encountered cases characterised by a slight curvature of the penis that was corrected after dissecting out the urethra over the full length of the penis. We call this "penile curvature due to anomalous disposition of the urethra", (Diaz Gomez, 1979) and it is remedied by moving the freed urethra 2-3 mm lower with the aid of sutures anchored to Buck's fascia.