Lich-Gregoir technique and routine use of double J catheter as the best combination to avoid urinary complications in kidney transplantation.

INTRODUCTION: Urinary complications in kidney transplantation cause patient morbidity and can decrease graft survival. Most of the complications stem from the vesicoureteric anastomosis. Different techniques for ureteroneocystostomy (UNC) have been designed to avoid these complications. The routine use of a double J catheter after the anastomosis has the same purpose. Our aim was to show our experience and compare the use or non-use of a double J catheter and different techniques for ureteric reimplantation with the rate of urologic complications. MATERIAL AND METHODS: We conducted a retrospective, nonrandomized study of 1011 renal transplantations performed between July 1985 and April 2012. We recorded the surgical techniques for UNC, the use or non-use of a double J catheter, and urinary complications (ureteric fistulae and strictures). The first 700 kidney transplantations (group A) were performed using several UNC techniques (Taguchi, Leadbetter-Politano, and Lich-Gregoir) with a selective use of double J catheter according to the criteria of the surgeon. In the last 311 patients (group B), a surgical technique was established (Lich-Gregoir), as well as the universal use of double J catheters. RESULTS: Urinary fistula occurred in 7% of group A patients and 2% of group B patients (P = .0001). Ureteric stricture occurred in 5.3% of patients in group A and 3% of group B patients (P = .09). In our study, routine prophylactic stenting combined with the Lich-Gregoir UNC technique has decreased the incidence of postoperative fistulae. CONCLUSIONS: Individually, the use of double J catheters seems to lessen the incidence of fistulae, although statistically, the difference is not significant. Accurate knowledge of the complications rates, recommendations of guidelines, and the early diagnosis are essential to attaining reasonable results in kidney transplantation.

Understanding respiratory syncytial virus infection to improve treatment and immunity.

Despite significant research since it was discovered more than 50 years ago, respiratory syncytial virus (RSV) continues to be the leading agent causing infant hospitalization and respiratory distress worldwide. Although RSV normally does not cause mortality, this virus is recognized as a major public health and economic burden around the globe. RSV can modulate host immunity leading to an inflammatory response that produces lung damage and virus dissemination in the host airways. Remarkably, infection with the virus elicits poor immunity that in most cases fails to protect against subsequent exposures. Here, we review advances made on the understanding of the lifecycle of the virus, some of the molecular mechanisms it has evolved to cause pathology and ineffective immunity during infection. Hopefully, ongoing research will contribute to developing new drugs and candidate vaccines that will decrease the health burden caused by this virus.

First Report of Fragaria chiloensis cryptic virus, Fragaria chiloensis latent virus, Strawberry mild yellow edge virus, Strawberry necrotic shock virus, and Strawberry pallidosis associated virus in Single and Mixed Infections in Strawberry in Central Mexico.

For phytosanitary purposes, the prevalence and incidence of viruses found in strawberry production within a centralized breeding program was investigated in Abasolo and Irapuato Counties, Guanajuato State, Mexico. Single and mixed infections of Strawberry mottle virus (SMoV) and Strawberry crinkle virus (SCV) were originally reported in the area (3), and subsequently, Strawberry latent ringspot virus (SLRSV) was also found (4). Samples of strawberry plants showing viral symptoms: stunting, mild chlorosis and reddening, occasional wrinkled, curled, and deformed leaves that may exhibit mottling, and chlorotic spots, forming a putative virus complex were collected in April and December 2007 and July and December 2008. The detection and identification of viruses reported in the United States, the country of origin of most of the imported plantlets, was carried out with sets of primers for 11 viruses, through reverse transcription (RT)-PCR (developed by Robert Martin and Ioannis Tzanetakis in Corvallis, OR). The endogenous NADH 2 subunit was employed to test the quality of the RNA extracted. Amplification conditions were: 40 cycles of 1 min at each temperature, denaturation at 95°C, annealing at 50°C for Strawberry necrotic shock virus (SNSV); 52°C for Strawberry mild yellow edge virus (SMYEV); 55°C for Fragaria chiloensis latent virus (FClLV), Strawberry pallidosis associated virus (SPaV), Fragaria chiloensis cryptic virus (FClCV), and SMoV; and 58°C for SCV and NADH dehydrogenase, followed by a final extension at 72°C of 5 min after completion of the 40 cycles. The cloning and nucleotide sequencing of amplified fragments revealed the presence of seven viral species in 40 samples collected. These were FClLV, SCV, SMoV, SNSV, SPaV, and SMYEV, which were allocated GenBank accession numbers of JQ629412, JQ629413, JQ629414, JQ629415, JQ629416, and JQ629417, respectively. Strawberry UC-4 and UC-10 (1,2) were planted as indicators of viral infections on an experimental plot. All seven viruses were detected in single or mixed infections. SMoV was the most commonly found in combination with other viruses. Out of 40 samples, 35 were positive for the presence of viruses and six had single infections, of which five had SMoV and one had SPaV. The remaining 29 samples had mixed infections with two or more viruses in a total of 22 combinations. The combination of FCICV + SMoV was present in five samples, whereas the combination of SMoV + SMYEV was in two samples. All other samples had two and up to six different viruses per plant. SMoV was detected in 26 out of the 40 samples tested. SNSV and FClCV were detected in 14 samples. SMYEV was present in 13 samples. SCV was present in nine samples, whereas SPaV and FClLV were found in eight samples each. To the best of our knowledge, this is the first report of FClLV, FClCV, SNSV, SMYEV, and SPaV in Mexico. References: (1) N. W. Frazier. Plant Dis. Rep. 58:28, 1974. (2) N. W. Frazier. Plant Dis. Rep. 58:203, 1974. (3) D. Teliz-Ortiz and A. Trejo-Reyes. Rev. Mex. Fitopatol. 7:38, 1989. (4) L. Pérez-Moreno et al. Rev. Mex. Fitopatol. 22:187, 2004.

A de novo unequal cross-over mutation between CYP11B1 and CYP11B2 genes causes familial hyperaldosteronism type I.

UNLABELLED: Familial hyperaldosteronism type I (FH-I) is an autosomal dominant disorder caused by an unequal cross-over of the gene encoding steroid 11ß-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2), giving rise to a chimeric CYP11B1/CYP11B2 gene that displays aldosterone synthase activity regulated by ACTH instead of angiotensin II. AIM: To report an unprecedented case of a de novo unequal crossover mutation between CYP11B1 and CYP11B2 genes causing FH-I. PATIENTS AND METHODS: The index case is a 45-yr-old Chilean male diagnosed with primary aldosteronism (PA). All family members were also studied: his biological parents, 1 brother, 6 sisters, 2 daughters, and 1 son. Plasma renin activity, serum aldosterone, and its ratio were measured in all patients. Genetic analyses were performed using long-extension PCR (XL-PCR), DNA sequencing and Southern blot methods. RESULTS: PA was diagnosed for the index case, 1 of his daughters, his son but not for his parents or siblings. XLPCR and Southern blotting demonstrated the presence of the chimeric CYP11B1/CYP11B2 gene solely in PA-affected subjects, suggesting a case of a de novo mutation. Sequence analysis showed the unequal cross-over CYP11B1/CYP11B2 at intron 2 (c.2600-273 CYP11B2). We also identified a polymorphism at the same intron (c.2600-145C>A CYP11B2) in the genome of the index case's father. CONCLUSION: We describe an unprecedented case of unequal cross-over mutation for the chimeric CYP11B1/CYP11B2 gene causing FH-I, which may be linked to a polymorphism in the index case's father germ line.

[Morbidity and risk factors of transrectal prostate biopsy]. / Morbilidad y factores de riesgo de la biopsia transrectal prostática.

OBJECTIVES: To evaluate the incidence of minor complications that rarely need treatment (haematuria, hematospermia and rectal bleeding) and major complications (fever and shock) in patients undergoing transrectal biopsy of the prostate and to identify risk factors. PATIENTS AND METHODS: We present an analytic and prospective study where we evaluated 146 patients subjected to transrectal biopsy of the prostate from December 2007 to September 2008. Complications rates and variables were analyzed. RESULTS: Eight patients (5,5%) suffered fever and seven (4,8%) of them were admitted. One of the patients (0,7%) suffered shock. The median of time between biopsy and fever was 3.5 days (1-10 days). Haematuria and hematospermia were more frequent in patients younger than 65 years (p<0.05) and fever and sepsis were more frequent in patients with prostate volume smaller than 55mL (p<0.05). CONCLUSIONS: The complications of the transrectal biopsy of the prostate are frequent, autolimited and they rarely suppose a health hazard for the patients. The most frequent are haematuria and hemospermia, specially in younger patients, whereas infectious complications are rarer and in our study are more frequent in patients with smaller prostates. We must take into account that the information to the patient is very important after a prostate biopsy, so we can avoid useless consultations (for example with haematuria) and it will enable to identify important signs like fever earlier.

[Hand-assisted laparoscopic nephrectomy in challenging cases]. / Nefrectomía laparoscópica asistida por la mano en casos difíciles.

OBJECTIVE: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. METHODS: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. RESULTS: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. CONCLUSIONS: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates.

[Does cystocele have a role in bladder outlet obstruction]. / ¿Es realmente el cistocele un factor de obstrucción infravesical?

INTRODUCTION: Controversy exists as to whether cystocele has a causative role in bladder outlet obstruction (BOO). OBJECTIVE: To assess the relationship between cystocele and bladder outlet obstruction. MATERIALS AND METHODS: Two hundred women undergoing a urodynamic study from December 2007 to December 2008 were retrospectively assessed. Patients were divided into two groups: Group A: Patients with no cystocele (Grade 0) and Grade I cystocele Group B: Patients with Grade II-IV cystocele. EXCLUSION CRITERIA: 1. Absence of flowmetry or voided volume < 150 ml. 2. Neurological disorders. 3. History of urogenital surgery. Bladder outlet obstruction was defined as follows: Postvoid residue (PVR) > 20%; peak flow (Qmax) < 15 ml/sec; detrusor pressure at maximum flow (PdetQmax) > 25 cm H2O. RESULTS: Group A included 64% of patients, and Group B the remaining 36%. A pathological PVR > 20% was found in 26.6% and 40.3% of patients in Group A and Group B respectively (p=0.04). A Qmax < 15 mL/sec was seen in 15.6% and 27.8% of Group A and Group B patients respectively (p=0.03). A PdetQmax > 25 cm H2O was found in 26.3% and 47.8% of Group A and Group B patients respectively (p=0.01). CONCLUSIONS: A statistically significant association exists between cystocele and bladder outlet obstruction.

Nefrectomía laparoscópica asistida por la mano en casos difíciles / Hand-assisted laparoscopic nephrectomy in challenging cases

Objetivo: evaluar los resultados de nefrectomía laparoscópica asistida por la mano en pacientes con masas renales técnicamente complejas. Métodos: se ha realizado una evaluación retrospectiva de 100 nefrectomías laparoscópicas realizadas en un solo hospital entre 2001 y 2005. Se ha seleccionado a los pacientes con antecedentes de cirugía abdominal previa, procedimientos previos en el riñón afectado, evidencia de inflamación perirrenal, lesiones renales de más de 10 cm de diámetro o trombosis venosa renal tipo I. Resultados: se ha incluido un total de 12 pacientes; 5 de ellos presentaban una lesión de al menos 10 cm de diámetro, dos trombosis venosa renal y 5 referían cirugía abdominal mayor. La mayoría de los pacientes tenía más de uno de estos hallazgos. Tres pacientes presentaban procesos inflamatorios (cálculos coraliformes) y un tumor renal T4 fue tratado con éxito, sin necesidad de reconversión. El tiempo operatorio y la pérdida sanguínea medias fueron de 210 minutos y 310 ml, respectivamente, con una estancia media de tres días. Ningún paciente requirió reconversión a cirugía abierta. Conclusiones: la nefrectomía laparoscópica asistida por la mano es una opción mínimamente invasiva, atractiva en el contexto de masas técnicamente complejas, con un tiempo operatorio, una pérdida sanguínea y una tasa de complicaciones razonables (AU)

Objective: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. Methods: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. Results: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. Conclusions: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates (AU)

¿Es realmente el cistocele un factor de obstrucción infravesical? / Does cystocele have a role in bladder outlet obstruction?

Introducción: existen controversias con respecto a si la presencia de cistocele, y el grado de este, es un factor de obstrucción del tracto urinario inferior (TUI).Objetivos: valorar la relación entre el cistocele y la obstrucción infravesical. Material y métodos: evaluamos retrospectivamente a 200 mujeres sometidas a estudio urodinámico, entre diciembre de 2007 y diciembre de 2008.Se clasificó a las pacientes en 2 grupos: Grupo A: ausencia de cistocele (grado 0) y grado I. Grupo B: cistocele grado II-IV. Criterios de exclusión: 1. Ausencia de flujometría libre o volumen vaciado < 150 ml. 2. Existencia de patología neurológica. 3. Antecedentes de cirugía urogenital. Definimos obstrucción del TUI según los siguientes parámetros: volumen residual postmiccional (VRP) > 20%; flujo máximo (Qmáx) < 15 ml/s; y presión del detrusor en el flujo máximo (PDetQmáx) > 25 cmH2O. Resultados: el grupo A incluyó al 64,0% de las pacientes y el grupo B al 36% restante. Seapreció volumen residual postmiccional (VRP) patológico en el 26’6% en el grupo A y en el 40,3% en el grupo B (p= 0,04); Qmáx < 15ml/s en 15,6% en el grupo A y en el 27,8% en el grupo B (p= 0,03); PDetQmáx > 25 cmH2O en el 26,3% en el grupo A y en el 47,8% en el grupo B (p= 0,01). Conclusiones: existe una asociación estadísticamente significativa entre el cistocele y parámetros de obstrucción infravesical (AU)

Introduction: Controversy exists as to whether cystocele has a causative role in bladder outlet obstruction (BOO).Objective: To assess the relationship between cystocele and bladder outlet obstruction. Materials and methods: Two hundred women undergoing a urodynamic study from December 2007 to December 2008 were retrospectively assessed. Patients were divided into two groups: Group A: Patients with no cystocele (Grade 0) and Grade I cystocele Group B: Patients with Grade II-IV cystocele. Exclusion criteria: 1. Absence of flowmetry or voided volume < 150 ml.2. Neurological disorders. 3. History of urogenital surgery. Bladder outlet obstruction was defined as follows: Postvoid residue (PVR) > 20%; peak flow(Qmax) < 15 ml/sec; detrusor pressure at maximum flow (PdetQmax) > 25 cm H2O. Results: Group A included 64% of patients, and Group B the remaining 36%. A pathological PVR > 20% was found in 26.6% and 40.3% of patients in Group A and Group B respectively (p=0.04). A Qmax < 15 mL/sec was seen in 15.6% and 27.8% of Group A and Group B patients respectively (p=0.03). A PdetQmax > 25 cm H2O was found in 26.3% and 47.8% of Group Aand Group B patients respectively (p=0.01). Conclusions: A statistically significant association exists between cystocele and bladder outlet obstruction (AU)

[Hyperintensity on T2 MRI and size as predictors of obliteration in radiosurgically treated arteriovenous malformations]. / Hiperintensidad en secuencias T2 y tamaño como factores pronósticos de obliteración en malformaciones arteriovenosas tratadas mediante radiocirugía.

OBJECTIVE: The aim of this study was to determine which factors were statistically related to radiological and clinical outcomes following radiosurgical treatment of arteriovenous malformations (AVMs). METHODS: The data of 59 patients receiving radiosurgical treatment at our department were retrospectivelly reviewed. Different clinical and biological data, including Spetzler-Martin grade, the presentation of symptoms, radiation dose, number of isocenters and both radiological and clinical outcome, were subjected to multivariate analysis. RESULTS: AVM obliteration was achieved in 77% of patients, the majority of them occurring between 3-5 years after treatment. Ten patients (17%) showed either acute or delayed complications. Only one patient died due tor hemorrhage during the follow-up after radiosurgery. A multivariate analysis showed that, hyperintensity on T2 MRI and a nidus smaller than 3 cm were the only factors statistically related to oclusion of the AVM (p=0.03 and p=0.05, respectively). CONCLUSION: The nidus size and the development of hyperintensity on T2 MRI after the treatment were the strongest predictive factors of obliteration in our series of AVMs radiosurgically treated. Moreover, given that many AVMs showed complete obliteration between 3-5 years after treatment, we recommend to wait untill 5 years after treatment before considering a new terapeuthic approach in patients showing small residual nidus at control imaging.

Hiperintensidad en secuencias T2 y tamaño como factores pronósticos de obliteraciónen malformaciones arteriovenosas tratadas mediante radiocirugía / Hyperintensity on T2 MRI and size as predictors of obliteration in radiosurgically treated arteriovenous malformations

Objetivo. Analizar retrospectivamente los factoresimplicados en la obliteración de las malformacionesarteriovenosas (MAVs) tratadas mediante radiocirugía.Métodos. Se revisaron retrospectivamente las historiasclínicas y las pruebas de imagen de 59 pacientescon MAVs tratados consecutivamente mediante tratamientoradioquirúrgico en nuestro Servicio. Se recogenlos datos demográficos y clínicos en el momentodel diagnóstico, así como los referentes al tratamientoempleado y la evolución de dichos pacientes.Resultados. Se consiguió la obliteración en el 77%de las MAVs tratadas. La obliteración completa seobservó en los primeros tres años en sólo el 40% de loscasos, mientras que en el resto, la obliteración ocurrióentre los tres y los cinco años. Diez pacientes (17%)sufrieron complicaciones agudas o crónicas. Sólo unpaciente murió como resultado de una hemorragiaintraparenquimatosa durante el periodo de seguimiento.El análisis multivariable utilizando los diversosfactores y parámetros potencialmente relacionadoscon la obliteración mostró que sólo la hiperintensidadperilesional observada en secuencias T2 de la RM yun tamaño del nidus menor de 3 cm incrementaron demanera estadísticamente significativa la probabilidadde oclusión completa (p=0,03 y p=0,05, respectivamente).Conclusión. Nuestros resultados, son similares a losreportados en otras series. Sin embargo, se obtuvo unamenor tasa de oclusiones en las MAVs >3cm de diámetro,confirmando que el tamaño es un factor determinanteen probabilidad de cierre de las MAVs tratadas (..) (AU)

Objetive. The aim of this study was to determinewhich factors were statistically related to radiologicaland clinical outcomes following radiosurgical treatmentof arteriovenous malformations (AVMs).Methods. The data of 59 patients receiving radiosurgicaltreatment at our department were retrospectivellyreviewed. Different clinical and biological data,including Spetzler-Martin grade, the presentation ofsymptoms, radiation dose, number of isocenters andboth radiological and clinical outcome, were subjectedto multivariate analysis.Results. AVM obliteration was achieved in 77% ofpatients, the majority of them occurring between 3-5years after treatment. Ten patients (17%) showed eitheracute or delayed complications. Only one patient dieddue tor hemorrhage during the follow-up after radiosurgery.A multivariate analysis showed that, hyperintensityon T2 MRI and a nidus smaller than 3 cm werethe only factors statistically related to oclusion of theAVM (p=0,03 and p=0,05, respectively).Conclusion. The nidus size and the development ofhyperintensity on T2 MRI after the treatment were thestrongest predictive factors of obliteration in our seriesof AVMs radiosurgically treated. Moreover, given thatmany AVMs showed complete obliteration between 3-5years after treatment, we recommend to wait untill 5years after treatment before considering a new terapeuthicapproach in patients showing small residual nidusat control imaging. (AU)

[Clinical efficacy of prostatic biopsy. Experience in our center from 1990 to 2002]. / Eficacia clínica de la biopsia prostática. Experiencia en nuestro centro 1990-2002.

INTRODUCTION: The prostate biopsy is the only valid tool to diagnose the existence of cancer of prostate. The indications of the biopsy, according with EAU, are the existence of high PSA, increased velocity PSA and a rectal suspicious tact. OBJECTIVES: validation of the utility of the prostate biopsy, to know the value of the PSA as a marker of prostate cancer in our way and to value the indication and efficiency of repeated biopsies. MATERIAL AND METHODS: we practice a manual review of the biopsies in our hospital, between the years 1990 and 2002. We study the level of PSA before the biopsy, number of prostatic cores and histologic information of the biopsy. A statistical descriptive and inferencial study has been performed by SPSS 12.0 package. RESULTS: The total number of biopsies registered was a 1202, with 36.96% of biopsy positive. The PSA before the biopsy (available in the biopsies realized between the year 1999 and 2002: 578 biopsies, 48.08% of the whole) was > 10 ng/ml in 55,88% of these patients, 4-10 ng/ml in 39.27% and 0-4 ng/ml in 4.84%. The average and PSA's median is of 19.09 (standard error: 1.87) and 10.6, respectively. The positividad of the biopsy increases with PSA's level: 48,61% with PSA > 10; 25.11% with PSA 4-10 and 21,4% in patients with PSA < 4. There was realized prostate rebiopsy (2 or more biopsies) in 132 patients (21.97% positive) 88,36% of the cancers was diagnosed in the first biopsy, and 6.62% in the second one (94,98% of the diagnoses of cancer of prostate carried out with the first 2 biopsies). CONCLUSIONS: The information obtained in the study by means of the descriptive analysis of our series meets in conformity the published in other studies and publications. There exists a need to increase the diagnostic profitability of the biopsy of prostate, for which we have introduced a protocol of biopsy under local anesthesia in order to be able to increase the number of obtained cylinders.

Eficacia clínica de la biopsia prostática. Experiencia en nuestro centro 1990-2002 / Clinical efficacy of prostatic biopsy. Experience in our center from 1990 to 2002

Introducción: La biopsia prostática es la única herramienta válida para diagnosticar la existencia de cáncer de próstata. Las indicaciones para su realización según la Asociación Europea de Urología son la existencia de PSA elevado, velocidad aumentada y la evidencia de un tacto rectal sospechoso. Objetivos: Valoración tanto de la utilidad clínica de la biopsia prostática, como del PSA como marcador de cáncer de próstata en nuestro medio y la indicación y eficacia de sucesivas biopsias. Material y Métodos: Efectuamos una revisión manual de las biopsias realizadas en nuestro servicio entre los años 1990 y 2002, valorando nivel de PSA previo a la biopsia, número de cilindros obtenidos y datos de la biopsia. Se llevó a cabo un estudio estadístico descriptivo mediante el programa estadístico SPSS 12.0. Resultados: Se han realizado 1202 biopsias en este periodo, con un porcentaje de positividad global del 36.96%. El PSA previo a la biopsia (disponible en las biopsias realizadas entre los años 1999 y 2002: 578 biopsias, 48.08% del total) era >10 ng/ml en el 55,88% de estos pacientes, 4-10 ng/ml en el 39.27% y 0-4ng/ml en el 4,84%. La media y mediana de PSA es de 19,09 (error típico: 1,87) y 10,6, respectivamente. La positividad de la biopsia aumenta con el nivel de PSA: 21,4% en pacientes con PSA<4; 25,11% con PSA 4-10 y 48,61% con PSA >10. Fue realizada rebiopsia prostática en 132 pacientes (21,97% positivas) El 88,36%de los cánceres fueron diagnosticados en la primera biopsia, y un 6,62% en la segunda (94,98% de los diagnósticos de cáncer de próstata se realizaron con las 2 primeras biopsias). Conclusiones: Los datos obtenidos en el estudio mediante el análisis descriptivo de nuestra serie se encuentran en concordancia con lo publicado en otros estudios y publicaciones. Existe una necesidad de aumentar la rentabilidad diagnóstica de la biopsia de próstata, para lo cual hemos introducido un protocolo de biopsia bajo anestesia local con el fin de poder aumentar el número de cilindros obtenidos (AU)

Introduction: The prostate biopsy is the only valid tool to diagnose the existence of cancer of prostate. The indications of the biopsy, according with EAU, are the existence of high PSA, increased velocity PSA and a rectal suspicious tact. Objectives: validation of the utility of the prostate biopsy, to know the value of the PSA as a marker of prostate cancer in our way and to value the indication and efficiency of repeated biopsies. Material and methods: we practice a manual review of the biopsies in our hospital, between the years 1990 and 2002. We study the level of PSA before the biopsy, number of prostatic cores and histologic information of the biopsy. A statistical descriptive and inferencial study has been performed by SPSS 12.0 package. Results: The total number of biopsies registered was a 1202, with 36.96 % of biopsy positive. The PSA before the biopsy (available in the biopsies realized between the year 1999 and 2002: 578 biopsies, 48.08 % of the whole) was> 10 ng/ml in 55,88 % of these patients, 4-10 ng/ml in 39.27 % and 0-4ng/ml in 4.84 %. The average and PSA’s median is of 19.09 (standard error: 1.87) and 10.6, respectively. The positividad of the biopsy increases with PSA’s level: 48,61 % with PSA> 10; 25.11 % with PSA 4-10and 21,4 % in patients with PSA <4. There was realized prostate rebiopsy (2 ó more biopsies) in 132 patients (21,97 % positive) 88,36 % of the cancers was diagnosed in the first biopsy, and 6.62 % in the second one (94,98% of the diagnoses of cancer of prostate carried out with the first 2 biopsies).Conclusions: The information obtained in the study by means of the descriptive analysis of our series meets in conformity the published in other studies and publications. There exists a need to increase the diagnostic profitability of the biopsy of prostate, for which we have introduced a protocol of biopsy under local anesthesia in order to be able to increase the number of obtained cylinders (AU)

Maternal hypothyroxinemia impairs spatial learning and synaptic nature and function in the offspring.

Neurological deficits in the offspring caused by human maternal hypothyroxinemia are thought to be irreversible. To understand the mechanism responsible for these neurological alterations, we induced maternal hypothyroxinemia in pregnant rats. Behavior and synapse function were evaluated in the offspring of thyroid hormone-deficient rats. Our data indicate that, when compared with controls, hypothyroxinemic mothers bear litters that, in adulthood, show prolonged latencies during the learning process in the water maze test. Impaired learning capacity caused by hypothyroxinemia was consistent with cellular and molecular alterations, including: 1) lack of increase of phosphorylated c-fos on the second day of the water maze test; 2) impaired induction of long-term potentiation in response to theta-burst stimulation to the Schaffer collateral pathway in the area 1 of the hippocampus Ammon's horn stratum radiatum, despite normal responses for input/output experiments; 3) increase of postsynaptic density protein 95 (PSD-95), N-methyl-D-aspartic acid receptor subunit 1, and tyrosine receptor kinase B levels in brain extracts; and 4) significant increase of PSD-95 at the PSDs and failure of this molecule to colocalize with N-methyl-D-aspartic acid receptor subunit 1, as it was shown by control rats. Our findings suggest that maternal hypothyroxinemia is a harmful condition for the offspring that can affect key molecular components for synaptic function and spatial learning.

Topiramato como coadyuvante en el tratamiento del trastorno por dependencia de alcohol en pacientes no respondedores: un estudio de 12 meses / Topiramate as add-on therapy in non-respondent alcohol dependant patients: a 12 month follow-up study

Introducción. El topiramato es un fármaco neuromodulador que posee diferentes mecanismos de acción que podrían estar implicados en la dependencia alcohólica. Se ha estudiado su utilidad tanto en estudios abiertos como en un ensayo doble ciego. Método. Se estudió en un grupo de pacientes ya en tratamiento por dependencia alcohólica (criterios CIE-10) con mala evolución (n=64) la utilidad y tolerabilidad del topiramato como coadyuvante en el programa de deshabituación mediante un estudio multicéntrico, abierto y prospectivo de 12 meses de duración. Para medir los resultados clínicos se utilizaron una escala visual de craving (EVC), una escala visual de priming (EVP), la Escala de Intensidad de dependencia alcohólica (EIDA), el número de días que bebían al mes y la cantidad bebida por el día en unidades de bebida estándar (UBE), así como parámetros analíticos como las transaminasas. Resultados. El topiramato redujo de forma significativa (p<0,001) todas las variables estudiadas, tanto las derivadas de las Escalas visuales Craving y Priming y la EIDA como el número bebidas/día y las UBE/día consumidas, así como los valores del volumen corpuscular medio y la gamma-glutamiltransferasa. La dosis media final fue algo inferior a 200 mg/día. Sólo tres pacientes abandonaron por intolerancia. Conclusiones. El topiramato mostró en condiciones asistenciales reales una buena respuesta clínica, medida tanto con la disminución de puntuación en escalas de dependencia y de craving-priming como con las bebidas referidas y las transaminasas, y parece ser un fármaco útil y bien tolerado para tratar a pacientes que presentan dependencia alcohólica y no responden adecuadamente a terapias estándar

Introduction. Topiramate is a neuromodulator drug with different action mechanisms that could be implicated in alcohol dependence. It has been studied in open and double-blind studies. Method. In a group of patients (n = 64) undergoing standard treatment for alcohol dependence (according to ICD-10 criteria) with poor outcomes, a 12 month observational, prospective and multicenter study was conducted to assess the usefulness and tolerability of topiramate as addon therapy. Outcome measures were retention rate, alcohol consumption (days of drinking per month and number of Standard Drink Units [SDU] per day, and results of Alcohol Dependence Intensity Scale [ADIS]), craving and priming visual scales and serum transaminase levels. Results. In these patients, adding topiramate leads to a significant decrease (p<0.001) in all the variables studied, including those derived from the craving and priming visual scales, the ADIS as well as the number of drinks/day and SDU/day consumed, the MCV and GGT values. Mean topiramate dose was almost 200 mg/day. Only three patients dropped out due to adverse reactions. Conclusions. Topiramate showed positive results for alcohol dependence in real clinical practice, with a significant decrease in craving-priming and dependence intensity scales, number of drinking days per month reported and transaminase levels. Topiramate seems to be a useful and well-tolerated pharmacological aid for patients with bad evolution in their alcohol dependence treatment

Topiramate as add-on therapy in non-respondent alcohol dependant patients: a 12 month follow-up study.

INTRODUCTION: Topiramate is a neuromodulator drug with different action mechanisms that could be implicated in alcohol dependence. It has been studied in open and double-blind studies. METHOD: In a group of patients (n = 64) undergoing standard treatment for alcohol dependence (according to ICD-10 criteria) with poor outcomes, a 12 month observational, prospective and multicenter study was conducted to assess the usefulness and tolerability of topiramate as addon therapy. Outcome measures were retention rate, alcohol consumption (days of drinking per month and number of Standard Drink Units [SDU] per day, and results of Alcohol Dependence Intensity Scale [ADIS]), craving and priming visual scales and serum transaminase levels. RESULTS: In these patients, adding topiramate leads to a significant decrease (p<0.001) in all the variables studied, including those derived from the craving and priming visual scales, the ADIS as well as the number of drinks/day and SDU/day consumed, the MCV and GGT values. Mean topiramate dose was almost 200 mg/day. Only three patients dropped out due to adverse reactions. CONCLUSIONS: Topiramate showed positive results for alcohol dependence in real clinical practice, with a significant decrease in craving-priming and dependence intensity scales, number of drinking days per month reported and transaminase levels. Topiramate seems to be a useful and well-tolerated pharmacological aid for patients with bad evolution in their alcohol dependence treatment.

[Hepatocarcinoma associated to fatty liver degeneration. Report of a clinical case]. / Hepatocarcinoma asociado a degeneración grasa del hígado. Presentación de caso clínico.

We report a case of hepatocellular carcinoma associated with fatty degeneration of the liver, which presented as and surgical acute abdomen, and was operated on at "Victorino Santaella" Hospital, being the first case observed at own Institution, and the only one reported in the national and international literature from 1971 to 1995.