'A sorrow shared ': a qualitative content analysis of what couples with recurrent miscarriages expect from one another and their families and friends.

STUDY QUESTION: When couples have to face recurrent pregnancy loss (RPL), what are the partners' wishes and needs and what is their perception of helpful and unhelpful factors with regard to their own, their partners' and their families' and friends' ways of dealing with the problem? SUMMARY ANSWER: Women and men with repeated miscarriages want open communication about their losses, but expect a sensitive and empathetic attitude from others, not pity or trivialization. WHAT IS KNOWN ALREADY: RPL not only causes the women affected and their partners considerable emotional distress; it also has an impact on the couples' relationships and the way they relate to their families and friends. Studies suggest that women have a greater need than their male partners to talk about their losses and that these differences may lead to dissatisfaction and cause relational tension. In addition, men often assume a 'mainstay' role, supporting their partners and displaying fortitude in the face of distress. As yet, however, little research has been conducted so far on the question of what the members of couples with RPL expect from one another and from their families and friends. STUDY DESIGN SIZE DURATION: The study sample consisted of 147 couples and 17 women with at least 2 miscarriages attending the special unit for RPL at the University Women's Hospital in Heidelberg (Germany) for the first time between September 2018 and October 2020 (response rate: 82.7%). The patients were asked to participate in this combined qualitative and questionnaire study. PARTICIPANTS/MATERIALS SETTING METHODS: In order to explore the wishes and needs of those affected in more detail, the free text responses obtained were examined in this study by using qualitative content analysis. Categories and subcategories were created inductively to summarize and systematize content. MAIN RESULTS AND THE ROLE OF CHANCE: Patients affected by RPL want their partners and their families and friends to deal with the topic openly and empathically. In the partnership itself, acceptance of individual grieving modes and sharing a common goal are important factors. Men, in particular, want their partners to be optimistic in facing up to the situation. Regarding communication with family and friends, it transpired that 'good advice', playing the matter down, inquiries about family planning, pity and special treatment are explicitly not appreciated. LIMITATIONS REASONS FOR CAUTION: The sample was a convenience sample, so self-selection effects cannot be excluded. In addition, the level of education in the sample was above average. Accordingly, the sample cannot be regarded as representative. The results of the content analysis are based on the respondents' written answers to open-ended questions in the questionnaire. Unlike qualitative interview studies, further questioning was not possible in the case of ambiguities or to request more details. WIDER IMPLICATIONS OF THE FINDINGS: Frank and sincere communication about miscarriages and about one's own emotions and needs should be promoted both in the partnership and among family members and friends in order to strengthen the potential of social support as a resource. Open communication about the different needs of both partners is necessary to create mutual understanding. The results show the importance not only of empathy and consideration for the couples concerned but also their desire not to be pitied. Striking a fine balance between fellow-feeling and pity may also lead to tension, and this potential dilemma should be addressed in psychosocial counselling. Overall, the study contributes to a better understanding of what couples want from their families and friends when they are attempting to come to terms with RPL and highlights potential challenges in the interaction between affected couples and their families and friends. STUDY FUNDING/COMPETING INTERESTS: No funding was received for this study. None of the authors declared any conflicts of interest. TRIAL REGISTRATION NUMBER: DRKS00014965.

Regional health workforce monitoring as governance innovation: a German model to coordinate sectoral demand, skill mix and mobility.

BACKGROUND: As health workforce policy is gaining momentum, data sources and monitoring systems have significantly improved in the European Union and internationally. Yet data remain poorly connected to policy-making and implementation and often do not adequately support integrated approaches. This brings the importance of governance and the need for innovation into play. CASE: The present case study introduces a regional health workforce monitor in the German Federal State of Rhineland-Palatinate and seeks to explore the capacity of monitoring to innovate health workforce governance. The monitor applies an approach from the European Network on Regional Labour Market Monitoring to the health workforce. The novel aspect of this model is an integrated, procedural approach that promotes a 'learning system' of governance based on three interconnected pillars: mixed methods and bottom-up data collection, strong stakeholder involvement with complex communication tools and shared decision- and policy-making. Selected empirical examples illustrate the approach and the tools focusing on two aspects: the connection between sectoral, occupational and mobility data to analyse skill/qualification mixes and the supply-demand matches and the connection between monitoring and stakeholder-driven policy. CONCLUSION: Regional health workforce monitoring can promote effective governance in high-income countries like Germany with overall high density of health workers but maldistribution of staff and skills. The regional stakeholder networks are cost-effective and easily accessible and might therefore be appealing also to low- and middle-income countries.

[Long-term care in Europe. Challenges and strategies in nursing staff management]. / Langzeitpflege im europäischen Vergleich. Herausforderungen und Strategien zur Sicherung der Pflegepersonalressourcen.

Across Europe, long-term care (LTC) is one of the most challenging areas of social policy. Despite a growing awareness of the problems and improved data, current institutional reforms are an ineffective response to demographic change. This article aims to provide an overview of the challenges of future nursing and care staff in LTC in Europe, and to discuss the German case in a wider European context. We focus on the nursing workforce and on the link between current and prospective analyses on the demand and offer of LTC services and LTC professionals/nursing staff. We draw on a secondary analysis of the literature and public statistics, especially OECD data. The European comparison shows a high variation in the future demand for LTC. In Germany, a number of problematic trends create a negative scenario: the growing demand for LTC meets with a decrease in nursing staff on the supply side. We conclude by suggesting intervention strategies that may reduce this negative scenario.

[Quality assurance in physiotherapeutic management: a gender-based analysis of health insurance data]. / Qualitätssicherung in der physiotherapeutischen Versorgung: eine geschlechterbezogene Analyse von Krankenkassendaten.

PURPOSE: Studies on the gender equivalence of health-care reveal differences in the handling of men and women that cannot be justified medically. This contribution analyses, for the example of physiotherapeutic management, whether a gender bias, as found for other medical fields, also exists in the provision of remedial interventions. METHODS: On the basis of the prescription data from a health insurance company (Gmünder Ersatzkasse, GEK), a gender-differential analysis of physiotherapy was undertaken. Prescription data for medications in the year 2005 were evaluated, differentiated according to the type of prescribed treatment, the age and gender of the insured person and the prescribing specialist group. Random samples were taken from the medicament prescriptions for further analyses. RESULTS: The analysis of prescription data revealed that, of the 1.6 million insured persons, 16.1% of the women (absolute: 119,354) and 11.7%of the men (absolute: 101,002) received at least one prescription for physiotherapy, the average age of all the insured persons receiving prescriptions for physiotherapeutic measures was 46 years for both sexes. Differential evaluation showed that women received a follow-on prescription slightly more frequently and that the number of treatment units per prescription was higher. Differences were also seen in the forms of the prescribed treatments. The data reveal a gender bias in physiotherapeutic management that can be explained by a differing compliance behaviour of the patient and prescribing behaviour of the physician. CONCLUSIONS: Accordingly, quality deficits also occur in the field of remedial interventions as a result of a gender bias, as has also been documented in other fields of medical management, especially with regard to the provision of medicaments.

Policy brief: how can optimal skill mix be effectively implemented and why?

Skill-mix initiatives focus on changing professional roles - directly and indirectly.They change roles directly through extension of roles or skills, delegation, andthe introduction of a new type of worker; they change them indirectly throughmodifications of the interface between services - that is, where care isprovided.Skill-mix initiatives may be motivated both by qualitative considerations (such asquality improvement, professional development and quality of work-lifeconcerns) and quantitative considerations (such as shortages, maldistributionand cost-effectiveness).Policy instruments that support the effective implementation of skill-mixinitiatives include:• modifying or introducing new professional roles through the developmentof different organizational and regulatory arrangements, includingregulating professional scopes of practice and overcoming institutionalbarriers;• supporting new or enhanced professional roles through collectivefinancing and altered financial incentives; and• ensuring the educational foundations (competence and capacity) for thenew and expanded professional roles.Across all initiatives, it is essential that the professional organizations affectedand the government support new professional roles.Skill-mix initiatives must be driven by need and must be sensitive to the healthsystem and health professional; one-size-fits-all approaches are not helpful.Optimal skill mixExecutive summaryThe first step towards determining and implementing an optimal skill mixwithin a health system involves defining the skill mix and achieving clarity aboutthe key policy problems for which it is envisioned as a solution.Skill-mix initiatives focus on changing professional roles directly or indirectly.Direct initiatives look at enhancement (by extending roles or skills), substitution,delegation and innovation (by introducing a new type of worker). Indirectinitiatives, however, modify the interface between services - that is, where careis provided; they consider transfer (by moving the provision of a service fromone health care setting to another), relocation (by shifting the location of aservice without changing the people who provide it) and liaison (by usingspecialists in one health care sector to educate and support staff working inanother sector).The problems for which skill mix can be a potential solution include: shortagesof certain provider groups and their maldistribution; rising health care costs andthe related desire to improve the cost-effectiveness of health care servicedelivery; and quality improvement, including addressing professionaldevelopment and quality of work-life concerns.The optimal skill mix has been determined in different ways in differentEuropean contexts and has been implemented in diverse ways, according to thecontext. Skill-mix initiatives have sometimes been driven by the need or desireto change the professional roles of established professions or to introduce newprofessional roles. At other times, the initiatives have been driven by the needor desire to pursue a new strategic direction for health systems that required ashift in existing professional roles. Among five European countries thatrepresent different types of welfare and health care systems - Finland,Germany, Spain, the Russian Federation and the United Kingdom - the mostextensive deployment has taken place in the United Kingdom, followed byFinland; in Germany, Spain and the Russian Federation, it has taken place to amuch lesser extent. Across all five countries, the initiatives that targetedchanges in professional roles typically included modifications to structuralfactors - particularly, legislation, regulation of the scope of practice,certification, education and training (usually the first to be modified), and oftenalso collective financing and the public provision of services.The development and implementation of advanced practice nursing in theUnited Kingdom provide useful insights that are applicable to other Europeanhealth systems. With significant support from government and a lack ofopposition from the dominant medical profession, this initiative has beenwidely implemented in the United Kingdom. Arguably, the relative success ofthis initiative is dependent on conducive contextual factors in the UnitedOptimal skill mixKingdom. The enabling contextual factors in the United Kingdom, however, arecritical to a better understanding of the viability of various skill mix approachesin other countries.The contextual factors that influence the implementation (and potential scalingup) of skill-mix initiatives include sensitivity to existing professional roles, theneeds of the health system, and support from government and relevantprofessional associations or unions, and these differ from country to country.These factors can operate at several levels: the structural (macro) level; theinstitutional (meso) level; and the interactional (micro) level. Policy instrumentsthat address skill-mix issues thus need to deal with:• modifying or introducing new professional roles through the developmentof different organizational and regulatory arrangements;• supporting new (or enhanced) professional roles through collectivefinancing and changing financial incentives; and• ensuring the educational foundations (competence and capacity) for newand expanded professional roles.In all cases, the support of the professions affected and the government isessential.As findings from studies of skill-mix initiatives are often difficult to generalize,two multistep approaches that move from identifying the problem and initiativeneeds to providing the capacity to undertake change and the choice of option -both of which reinforce the importance of the contextual elements - arehighlighted in the concluding section of the policy brief. These multistepapproaches can help health system managers and policy-makers determinewhether and which skill-mix initiatives should be undertaken. Overall, however,changing services, which may require a shift in skill mix, may be a moreeffective approach than changing the skill mix directly.

Tratamiento de la incontinencia urinaria de esfuerzo con banda suburetral con ajuste de tensión: informe preliminar / Stress urinary incontinence treatment with suburethral band with tension adjusment: preliminary report

El objetivo del presente trabajo es evaluar los resultados preliminares de esta nueva técnica con respecto a eficacia y morbilidad. Fueron intervenidos 15 pacientes diagnosticados con distintos grados de incontinencia urinaria de esfuerzo (I-II-III). Procedimientos efectuados entre noviembre del 2000 y agosto del 2001 con un seguimiento promedio de 4 meses (1-9 meses). El diagnóstico clínico fue con test de Marshall en todas las pacientes más medición de la presión de escape en tres pacientes. La técnica quirúrgica se realizó con anestesia raquídea siguiendo los pasos descritos por el autor del TVT más el ajuste de tensión propuesto por Mac Millan. El tiempo operatorio promedio 45 minutos (30-60 minutos); una paciente tuvo lesión trasfixiante de vejiga que se diagnóstico y resolvió durante el mismo acto operatorio. El retiro de sonda fue promedio a las 27 horas con alta inmediata posterior al retiro de sonda (24-72 horas). No hubo pacientes con retención urinaria postoperatoria. Infección urinaria en una paciente. Para evaluar la efectividad del procedimiento se consignó mejoría completa en 14 pacientes (93 por ciento) mejoría parcial en una paciente (7 por ciento) y las mediciones postoperatorias de uroflujo en promedio 23 ml/seg. (entre 15-38 ml/seg.) y las mediciones de los residuos post miccionales fueron en promedio 21 ml. (75-0 ml). La nueva técnica, con la modificación descrita, puede ser utilizada en pacientes con incontinencia urinaria en sus diversos grados. Tiene las ventajas de la simplicidad, fácil aprendizaje, baja morbilidad y se acerca a los requisitos de una nueva técnica para la incontinencia, ya que mejora la continencia sin comprometer el flujo y sin dejar residuos post miccionales significativos. Estos son datos preliminares que requieren de un mayor número de pacientes y un seguimiento a largo plazo para su validación.

Retinoic acid delays transcription of human retinal pigment neuroepithelium marker genes in ARPE-19 cells.

The effect of retinoic acid on the differentiation of a human retinal pigment epithelium-derived cell line ARPE-19 was studied. Differentiation of ARPE-19 cells is delayed by retinoic acid. The minimum all-trans-retinoic acid concentration needed for delay of ARPE-19 differentiation is 1 microM. A delay of differentiation was also observed using 1 microM 9-cis or 13-cis-retinoic acid. Differentiation at the molecular level was studied by analyzing transcription of two RPE-marker genes, RPE65 and peropsin. In the presence of 1 microM retinoic acid the onset of transcription of both genes was delayed by 2-3 weeks. We conclude that all-trans-, 9-cis-, and 13-cis-retinoic acid delay differentiation of ARPE-19 cells into cells that phenotypically resemble cells from the human retinal pigment epithelium.

Retinoic acid receptors and retinoid X receptors in the mature retina: subtype determination and cellular distribution.

PURPOSE: In the mature retina retinoic acid (RA) biosynthesis was reported to be regulated by light. RA is of vital importance for proper function of the retina. RA activity is mediated by interaction with nuclear retinoic acid receptors (RARs) and retinoid X receptors (RXRs). The purpose of this study was to determine if and which RARs and RXRs are present in the mature retina, and to determine their location within the retina. METHODS: The reverse transcriptase polymerase chain reaction (RT-PCR) was used to amplify cDNA fragments encoding RARalpha, RARbeta, RARgamma, RXRalpha, RXRbeta, and RXRgamma from human retinal RNA. RT-PCR products were cloned, sequenced, and used in Northern blot experiments. Antibodies directed against each receptor subtype were used for immunocytochemical analysis. RESULTS: RT-PCR and Northern blot analysis indicated that all RAR and RXR subtypes are present in the mature retina. Western blot analysis, using a cytoplasmic protein fraction isolated from the bovine and human neural retina, showed the presence of RXRalpha. Immunocytochemical analysis of the human, bovine, and rat retina showed that RARalpha is highly expressed in the outer segments of cone photoreceptor cells. RXRalpha expression was observed in the rod inner segment layer. RXRgamma was detected in the nuclei and outer segments of cone photoreceptor cells. CONCLUSIONS: The retinal expression pattern of RARs and RXRs is heterogeneous. The observation that RXRalpha is present in rods whereas RARalpha is present in cones, suggests a mechanism by which RA that is produced upon bleaching, could generate different responses in the two photoreceptor cell subtypes.

The visual cycle retinol dehydrogenase: possible involvement in the 9-cis retinoic acid biosynthetic pathway.

The 11-cis-retinol dehydrogenase (11-cis-RoDH) gene encodes the short-chain alcohol dehydrogenase responsible for 11-cis-retinol oxidation in the visual cycle. The structure of the murine 11-cis-RoDH gene was used to reinvestigate its transcription pattern. An 11-cis-RoDH gene transcript was detected in several non-ocular tissues. The question regarding the substrate specificity of the enzyme was therefore addressed. Recombinant 11-cis-RoDH was found capable of oxidizing and reducing 9-cis-, 11-cis- and 13-cis-isomers of retinol and retinaldehyde, respectively. Dodecyl-beta-1-maltoside used to solubilize the enzyme was found to affect the substrate specificity. This is the first report on a visual cycle enzyme also present in non-retinal ocular and non-ocular tissues. A possible role in addition to its role in the visual cycle is being discussed.

Uveitogenic 28/30 kD and 43 kD polypeptides in pigment epithelial membranes of the retina.

UNLABELLED: The purpose of this study was the search for new intrinsic polypeptides of the retinal pigment epithelium (RPE) capable of evoking experimental uveitis. A membrane fraction was prepared from purified bovine RPE cells. The Triton X-100 soluble protein fraction was separated into polypeptide fractions by preparative gel electrophoresis, and the pathogenicity of the main isolated polypeptides was investigated in Lewis rats. After immunization, two hitherto unknown pigment epithelial polypeptides with M(r) 28/30 kD (doublet) and 43 kD (PEP-28/30 and PEP-43, respectively) elicited progressive pigment epitheliitis and choroiditis accompanied by extending plaque-shaped macrophage accumulations along the RPE-Bruch's membrane layer. No inflammatory foci were found within the neural retina. Polypeptide fractions with M(r) 14-17, 25 and 32/34 kD (doublet) (PEP-14/17, PEP-25 and PEP-32/34, respectively) appeared to be non-uveitogenic at the tested dose. PEP-28/30 and PEP-43 exhibited a partial antigenic relationship to PEP-65. PEP-28/30 exhibited marked reactivity to a monoclonal antibody previously raised to a 32 kD RPE-specific protein. IN CONCLUSION: in addition to the previously described main RPE-specific membrane polypeptide PEP-65, the RPE appears to contain two more uveitogenic components, the intrinsic pigment epithelial membrane polypeptides PEP-28/30 and PEP-43. Like PEP-65, these antigens are able to evoke experimental autoimmune pigment epithelial protein-induced uveitis (EAPU) in rats.

Differential effect of macrophage depletion on two forms of experimental uveitis evoked by pigment epithelial membrane protein (EAPU), and by melanin-protein (EMIU).

The purpose of the present study was to clinically and histologically investigate the influence of macrophage depletion on the development of experimental autoimmune pigment epithelial membrane protein-induced uveitis (EAPU), and experimental melanin-protein induced uveitis (EMIU) in the Lewis rat. EAPU is mainly characterized by pigment epitheliitis. Posterior mononuclear cell accumulations enclose and destroy the retinal pigment epithelium (RPE). In EMIU the inflammation is specifically localized in the uvea. EAPU was induced by immunization with RPE membrane protein, and EMIU was evoked by immunization with purified choroidal melanin. Systemic treatment with dichloromethylene diphosphonate (Cl2MDP)-containing liposomes just before the expected beginning of the clinical signs of EAPU (at day 7 and 9 after immunization) resulted in a considerable delay of the uveitis process. In the treated animals the typical plaque shaped cell accumulations (containing many macrophages) along the RPE were lacking. Two weeks after the treatment, severe rebound EAPU developed. Local treatment by subconjunctival liposome injections did not exert any effect on EAPU. In EMIU, macrophage depletion by systemic treatment did not noticeably influence the clinical and histological development of the inflammation. Systemic treatment at the peak stage of EAPU (at day 12 and 14 after immunization) resulted in the rapid disappearance of the clinical signs of uveitis. Vitreous and anterior chamber cells were virtually absent two days later. This situation remained unchanged until the experiment was terminated two weeks later. Already deposited cell accumulations along the RPE did not regress but stopped their progression. Hematogenous macrophages thus appear to play a crucial role in the development of EAPU but the effect of early macrophage depletion on EAPU appeared to be temporary due to blood repopulation. A possible explanation for the differential influence of macrophage depletion on EAPU and EMIU is discussed, and is based on differences in immunopathogenesis.

Macrophage subpopulations and RPE elimination in the pathogenesis of experimental autoimmune pigment epithelial protein-induced uveitis (EAPU).

Experimental autoimmune pigment epithelial protein-induced uveitis (EAPU) is a new type of disease that destroys the retinal pigment epithelium (RPE), and exhibits a hitherto unknown form of progressive chorioretinal dystrophy in which neuroretinal inflammatory foci are absent. The present study was aimed at studying the expression of adhesion molecules, and the kinetics of the appearance of the main types of macrophages and other intraocular immunocompetent cell populations in the various stages of this disease. EAPU was evoked in Lewis rats by immunization with the membrane protein from bovine RPE cells containing PEP-65 as main constituent. In the uvea, increased expression of intercellular adhesion molecule-1, of class II major histocompatibility complex antigen, and of ED2 macrophage reactivity were observed closely before the onset of EAPU. Expression of these reactivities was also slightly elevated by injections of the applied adjuvants alone. The onset of EAPU was mainly characterized by initial uveal infiltrations of ED1+ macrophages and a minor population of CD4 T cells, and an increase in ED3, ED7 and perivascular ED2 reactive macrophages. This was followed by the development of focal accumulations of ED1+ cells at both sides of the Bruch's membrane-RPE layer (Dálen-Fuchs nodules) which was permeated and disintegrated at these sites. The outer choroidal layer, the anterior iridal surface, and the base of the ciliary body more frequently contained active inflammatory cells than the other uveal areas. Lymphoid cells were found scattered through the uvea, aqueous and vitreous. The sites of increased activity of ED2+ and ED3+ cells in the uvea were rather similar to those of ED1 macrophages in the various stages of EAPU. Starting from multiple foci, the process of the formation of plaque-shaped cell accumulations in severe EAPU progressed along the RPE and exhibited a chronic character. The results of this study show that ED1+, ED2+, ED3+ and ED7+ subpopulations of macrophages are actively involved in an immunopathological process in which the RPE is the target. The thickening of the plaque-shaped cell accumulations stops if the integrity of all RPE cells at that site has been affected. We postulate that this is the result of antigen elimination while additional influence of the abrogation of RPE cytokine production is presumed.

Experimental melanin-protein induced uveitis (EMIU) is the sole type of uveitis evoked by a diversity of ocular melanin preparations and melanin-derived soluble polypeptides.

Experimental melanin-protein induced uveitis (EMIU) is a CD4 T cell-mediated disease involving the choroid and iris, but sparing the retina. The present study was designed to solubilize uveitogenic antigen from melanin granules without enzymatic digestion, and to investigate some of its elements by comparison with different purified melanin preparations. Many melanin surface-derived polypeptides with molecular weights ranging from 1 to > 100 kDa were obtained by extractions of the prepurified granules with hot lithium dodecyl sulfate (LDS). The mixture was electrophoretically separated into seven subfractions, each containing many components and capable of evoking the typical features of EMIU after footpad immunization of Lewis rats. The five low-molecular-weight fractions between M, 1 kDa and 30 kDa exhibited most pathogenicity which was evenly distributed among the fractions. Highly uveitogenic material remained in the melanin preparations even after multiple exhaustive extractions with LDS, and represented about 70% of the detectable protein. The uveal pathogen (UP-X) thus proved to be antigenically stable, and the major part of the pathogenic material was strongly bound to the granule surface layer. Concentrated urea solution was also capable of extracting many uveitogenic melanin polypeptides, but in a different composition than LDS did, and less effectively. Human choroidal melanin provided an LDS-soluble fraction with low pathogenicity. A single intraperitoneal injection of bovine melanin polypeptides together with pertussis toxin, but without footpad immunization in Freund's complete adjuvant, evoked EMIU as well. In all experiments, no uveitis except EMIU was observed, indicating that only one type of uveitogenic epitope was present in a wide variety of carrier molecules. An explanation for this phenomenon is discussed.

Eficacia del láser Nd: YAG en el tratamiento del adenoma prostático obstructivo: comparación de dos técnicas / Efficacy of Nd: YAG laser in obstructive prostatic adenoma treatment: comparisson between 2 technics

Se trató de comprobar la eficacia del láser Nd:YAG en el tratamiento del adenoma prostático obstructivo y comparar dos técnicas diferentes. Se trataron 31 pacientes portadores de un adenoma prostático obstructivo cuyo peso promedio fue de 41.6 grs. Se utilizó un equipo láser Sharplan 3000 con una fibra de disparo lateral Side Trak. Se crearon dos grupos; el grupo I de 16 pacientes tratados con la técnica de 60 watts por segundos y el grupo II de 15 pacientes con la técnica de 40 watts por 90 segundos. El estudio postoperatorio fue básicamente valorando el tiempo del reinicio de la micción, los síntomas inmediatos, el control del score AUA y el flujo urinario. El tiempo promedio de seguimiento fue de tres meses. La mejoría sintomática global fue del 60.8 por ciento; 56.2 por ciento en el grupo I y de 63 por ciento en el grupo II. La mejoría objetiva del flujo urinario fue de 76.8 por ciento; 62.5 por ciento y 94.9 por ciento respectivamente. El tiempo promedio para reiniciar la micción fue de 7.19 días. La gran mayoría de los pacientes (87.1 por ciento) presentaron síntomas irritativos durante las primeras dos semanas después de la operación. Luego de 3 meses de seguimiento, ningún paciente ha requerido retratamiento ni tampoco se han presentado complicaciones urológicas. La ablación prostática por láser Nd:YAG es un procedimiento sencillo, seguro y eficaz en el tratamiento del adenoma prostático obstructivo. La técnica de baja intensidad utilizada en el grupo II fue superior a la del grupo I en la mejoría del flujo urinario

Multiple recurrences in melanin-protein-induced uveitis in the rat.

The purpose of the present study was to investigate the occurrence and sequelae of multiple recurrences in experimental melanin-protein-induced uveitis (EMIU). Lewis rats were immunized with purified bovine choroidal melanin granules, and the development of EMIU was studied during six months. Multiple recurrences were observed in virtually all rats that developed primary EMIU. The spontaneous recurrences exhibited an increasingly mild character and a decreasing frequency over time. They occurred one to four times per eye with intervals of five to six weeks. If the inflammations were more severe or chronic the uveal tissues were more seriously damaged. The anterior uvea became slender by loss of cells and stroma during the process suggesting a role as target. Unlike in primary EMIU, the retina finally exhibited areas with damage of the photoreceptor and pigment epithelial cells. Mononuclear cells were the predominant inflammatory cell type in the entire uvea in eyes with serious recurrences or chronic uveitis. The number of recurrences per se did not correlate with the extent of tissue damage but the overall severity of the disease over six months did. In rats recovered from mild recurrences, a single injection of pertussis toxin, or melanin granules emulsified in Freund's incomplete adjuvant was sufficient to reinduce severe EMIU with extensive damage of the uvea. Hence, specific as well as aspecific stimulation of the immune system caused severe recurrences of this type of uveitis. EMIU resembles non-infectious human anterior uveitis in several respects, even in its multiple recurrences.

Cirugía laparoscópica en quistes renales simples: un avance / Laparoscopic surgery in simple renal cysts: an advance

Los quistes renales simples sintomáticos requieren de un tratamiento quirúrgico. Con la introducción de la vía laparoscópica como un nuevo método de abordaje en cirugía urológica, se ha abierto una nueva modalidad terapéutica para estos casos evitando así la cirugía convencional por lumbotomía.En el período marzo 1993 - junio 1994 se intervinieron cinco pacientes, cuatro mujeres y un hombre con quistes renales simples por vía laparoscópica cuya técnica se describe en detalle. Hubo una conversión a cirugía abierta por adherencias secundarias a cirugía previa. Debido a los buenos resultados obtenidos sin morbimortalidad y a las ventajas evidentes, se propone esta nueva técnica quirúrgica como una alternativa en el manejo de quistes renales simples sintomáticos

Mutated c-K-ras in small pancreatic adenocarcinomas.

The objective of this study was to determine whether small human pancreatic adenocarcinomas contain activated c-K-ras as an approach to answering the question of whether c-K-ras mutation is an early change in this disease. Eight pancreatic adenocarcinomas in the range 1.2-3 cm were analyzed for c-K-ras mutation at codon 12 by amplifying the c-K-ras gene around codon 12 out of paraffin-embedded tissue sections using the polymerase chain reaction. c-K-ras mutations were detected by allele-specific oligonucleotide hybridization. Six of the eight small pancreatic adenocarcinomas contained mutated c-K-ras at codon 12, position 2, and two of the six tumors had an additional mutation at position 1 of codon 12. Our results indicate that small pancreatic adenocarcinomas are similar to large, late-stage pancreatic adenocarcinomas in that 75% of the tumors analyzed contain mutated c-K-ras at codon 12, position 2. These data suggest that c-K-ras mutation occurs early and may therefore have a role in initiation of human pancreatic adenocarcinoma.