Reproductive long-term effects, endocrine response and fatty acid profile of rabbit does fed diets supplemented with n-3 fatty acids.

The effect of a diet enriched with polyunsaturated n-3 fatty acids (PUFA) on endocrine, reproductive, and productive responses of rabbit females and the litters has been studied. Nulliparous does (n=125) were fed ad libitum from rearing to second weaning two diets supplemented with different fat sources: 7.5g/kg lard for the control diet (group C; n=63) or 15g/kg of a commercial supplement containing a 50% ether extract and 35% of total fatty acids (FAs) as PUFA n-3 (Group P; n=62). Dietary treatments did not affect apparent digestibility coefficients of nutrients, or reproductive variables of does including milk production, mortality and average daily gain of kits over two lactations. However, on Day 5 and 7 post-induction of ovulation, progesterone of Group P tended to increase to a greater extent than in does of Group C. Total PUFAs, n-6 and n-3 and eicosapentanoic (EPA) contents were greater in adipose tissues of does in Group P than in Group C. Docosapentaenoic acid (DPA), EPA, and docosahexaenoic acid (DHA) concentrations were greater in peri-ovarian than in scapular fat with abdominal fat being intermediate in concentration. In PUFA supplemented does, kit mortality at the second parturition tended to be less than in control does. Also, kits born to does of the PUFA-supplemented group weighed more and were of greater length than from does of control group. In conclusion, effectiveness of dietary intervention on reproductive and performance response is greater in the second parity, which suggests an accumulative long-term beneficial effect of n-3 FA supplementation in reproductive rabbit does.

[Utility of endoscopy in digestive hemorrhage due to vasculitis]. / Utilidad de la endoscopia en la hemorragia digestiva por vasculitis.

Vasculitides constitute a heterogeneous group of diseases characterized by inflammation of blood vessels. The skin is mainly affected, although the gastrointestinal tract mucosa can also be involved. The contribution of endoscopy in these cases has not been clearly determined. We report three cases of systemic vasculitis (polyarteritis nodosa, Schonlein-Henoch purpura and Behcet's disease) presenting with acute digestive bleeding. Endoscopy was an effective technique for completing the diagnosis and in establishing an effective nonsurgical therapeutic approach in these potentially lethal cases of gastrointestinal hemorrhage.

Collagenous colitis and lymphocytic colitis: clinical and endoscopic findings.

OBJECTIVE: collagenous colitis (CC) and lymphocytic colitis (LC) are two entities of unknown cause, characterized by chronic watery diarrhea, grossly normal-appearing colonic mucosa and abnormal histopathological findings in colonic biopsies. The clinical features of the disease are based mainly on case reports or small uncontrolled series. Although normal colonoscopic findings are, as a rule, part of the diagnosis of CC, several cases of macroscopic colitis associated with CC have been reported, and the spectrum of endoscopic mucosal changes has not been described in large series. METHODS: we present a retrospective study of all patients who underwent total colonoscopy and mucosal biopsy in our Endoscopy Unit between 1991 and 1997. Clinical and endoscopic findings in patients diagnosed as having CC or LC were recorded. RESULTS: of 676 patients studied, 398 suffered from chronic diarrhea. Collagenous colitis was diagnosed in 22 patients and LC in 10. Eleven per cent of the patients with CC and 20% of those with LC did not have diarrhea. Macroscopic colitis was observed in 6 out of 22 patients with CC (27%) and in 4 out of 10 with LC (40%). Macroscopic lesions included edema, erythema, abnormal vascular pattern, superficial erosions or ulcerations and hemorrhagic lacerations. In this series 7.03% of the patients with chronic diarrhea were diagnosed as having CC or LC. CONCLUSIONS: collagenous colitis and LC are two entities that should be considered in the differential diagnosis of chronic diarrhea. Total colonoscopy with multiple biopsies that include the right colon are mandatory. The presence of macroscopic lesions on endoscopy does not rule out a diagnosis of either entity. We identified patients who fulfilled the histopathological criteria for CC or LC but who did not have diarrhea.

[Complications of endovesical treatment with BCG in a series of 200 patients]. / Complicaciones del tratamiento endovesical con BCG en una serie de doscientos pacientes.

OBJECTIVE: To describe and quantify the side effects of intravesical BCG therapy (Connaught strain) in different therapeutic protocols. METHODS: 200 patients were studied; 126 treated according to the standard protocol of our hospital (modality 1 and modality 2: twelve and nine 81 mg instillations, respectively) and 74 patients in the CUETO protocols (90008, 93009, 95011, 95012). Classification of BCG toxicity was based on the criteria utilized by Lamm which divides it into side effects and complications. We have distinguished side effects further as local irritative symptoms (LIS) and cystitis. RESULTS: The most common side effects were LIS (80%) and cystitis (21.5%). The incidence of cystitis (44.4%) and general malaise (44.4%) was higher for modality 1 than for modality 2 (24.1% and 20.3%, respectively). The CUETO 93009 protocol (mitomycin + BCG) showed the highest incidence of side effects (LIS 100%, cystitis 57.1% and fever < 39 degrees C 71.4%). The most frequent complication was fever > 39 degrees C (4%), followed by hepatitis (3%). The rate of bladder retraction was notably high (1.5%), requiring cystectomy with neobladder substitution in two cases. The overall complication rate for modality 1 (16.6%) was reduced when modality 2 was utilized (8.3%). In the CUETO 90008 protocol, dose reduction did not reduce the complication rate (81 mg: 7.1%; 21 mg: 19.2%). BCG therapy was discontinued in 14%. CONCLUSIONS: Toxicity due to intravesical BCG therapy did not decrease when the dose was reduced, but diminished in number and intensity when the number of consecutive instillations was reduced.

[Reiter syndrome: atypical complication of treatment with BCG]. / Síndrome de Reiter: una complicación atípica del tratamiento con BCG.

OBJECTIVE: To report a case of Reiter's syndrome, an uncommon complication after intravesical BCG therapy. The etiology, clinical features, diagnostic difficulties and treatment of this condition are discussed. METHODS/RESULTS: A 56-year-old patient with superficial bladder carcinoma developed conjunctivitis, urethritis and arthritis of the right knee and wrist after the fourth BCG instillation. Other pathologies were ruled out by the clinical and laboratory findings (synovial fluid, cultures, HLA B-27, RF, ANA). A progressive clinical improvement was observed when BCG instillation was discontinued and treatment with indomethacin was started. CONCLUSION: Reiter's syndrome is an infrequent complication that is not related with the BCG strain utilized. Early diagnosis of this condition improves response to therapy.

[Fracture of the penis: value of echo-Doppler-color]. / Fractura de pene: valor del eco-doppler-color.

OBJECTIVE: A case of traumatic rupture of the corpora cavernosa evaluated by color Doppler ultrasonography is presented. METHODS: A 43-year-old male consulted for a large penile hematoma that had presented 16 hours earlier during sexual intercourse. The patient was evaluated by Doppler ultrasound using a 5 Mhz linear probe. The vascular integrity of the penis was demonstrated by color Doppler ultrasonography of the cavernous arteries and penile veins. RESULTS: Disruption at the base of the right corpus cavernosum associated with a small hematoma appeared as adjacent hypoechoic images. The color Doppler ultrasonic evaluation demonstrated the integrity of the arteries and cavernous veins and no pulsation of the hematoma, indicating conservative management. Four months after the trauma, no changes in erectile function or penile deviation have been observed. CONCLUSIONS: Color Doppler ultrasound is a useful diagnostic imaging technique in the assessment and follow-up of penile trauma.

[Metanephric renal adenoma]. / Adenoma metanéfrico renal.

OBJECTIVE: To describe a case of metanephric adenoma, a rare and little known tumor with no potential to malignancy. This tumor type can occasionally coexist with Wilms' tumor, with which it is histogenically related. METHODS/RESULTS: A 54-year-old female patient was referred to the Urology Service for a small mass in the left kidney that had been incidentally detected during an ultrasound evaluation. Patient evaluation disclosed a solid, circumscribed, unencapsulated mass of 2.3 cm in its largest segment. It was mainly localized in the medulla of the kidney, although it was extensively in contact with the renal cortex. Histologically, it was comprised of small epithelial cells in a tubular or papillary arrangement, without atypia, mitosis, necrosis or invasion of adjacent renal parenchyma or vascular structures, and with abundant psammoma-like calcifications. The histological findings were characteristic of metanephric adenoma. CONCLUSION: Metanephric adenoma is an uncommon, morphologically distinct tumor type, with characteristic histopathological features. Despite its size, it is benign and should be distinguished from renal cell carcinoma or Wilms' tumor.

[Barrett's esophagus]. / Esófago de Barrett.

Barrett's esophagus (BE), a complication of gastroesophageal reflux disease, is the replacement of squamous tissue with specialized intestinal metaplasia. Other noxious factor, as biliary acids, may contribute to the induction of BE. It is a premalignant condition, and adenocarcinoma arises in some cases. An endoscopic surveillance with multiple biopsies is mandatory to detect different grades of dysplasia or intramucosal cancer and allow effective therapy. Since its prevalence is high, current surveillance protocols become expensive and patient's compliance is difficult. The main medical goals are: 1) To stratify individuals without dysplasia as either lower or higher risk, to screen less often those at lower risk. 2) To obtain complete remission or eliminate the risk of cancer and the need for surveillance. Current treatments have not demonstrate complete regression of metaplasia. Recently, new endoscopic approaches to therapy have been developed. Although they remain experimental and larger series are required, initial results are encouraging.

[Distal detubularized sigmoidoplasty (Canarian neobladder). Midterm functional evaluation]. / Sigmoidoplastia distal destubulizada (Neovejiga Canaria). Valoración funcional a medio plazo.

OBJECTIVE: The aim of this report is to evaluate the medium term clinical and urodynamic results of the distal detubularized sigmoid neobladder, which we have called the "Canarian neobladder". METHODS: Since April, 1992, we have performed 26 orthotopic neobladder substitution using this particular technique. Ten patients were excluded from the study: two patients with early cancer progression; one female patient; one patient that had died a few days after the operation and 6 patients with less than 16 months follow-up. The remaining 16 patients were evaluated and had a mean follow-up of 22 months (range 6-54). We have performed clinical, urodynamic, radiographic and metabolic evaluation every six months during the first year and every 12 months thereafter. Clinical evaluation included daytime frequency, daytime and night-time urinary incontinence, urge and patient satisfaction with the clinical results. Flowmetry, cystometry and pressure-flow test were performed. The upper urinary tract was evaluated by renal ultrasound or pyelography. Entero-ureteral reflux was discarded by cystography. The International Continence Society terminology was utilized and clearly specified if otherwise. RESULTS: 87.5% of the patients were continent during the daytime and only two cases had diurnal urinary incontinence. Seventy-five percent of the patients had night-time incontinence and required external devices for its management. At two years follow-up, the mean diurnal frequency was 180 minutes and the mean bladder capacity was 338.2. First sensation was noted at 70.6% of bladder capacity. The neobladder pressure at maximum capacity during the filling phase was less than 30 cm H2O in all cases. Involuntary bladder contractions were demonstrated during cystomanometry in 93.7%. The pressure-flow test demonstrated neobladder contraction in 50% of cases and combined with abdominal straining in 50%. The foregoing allowed application of passive urethral resistance ratio (PURR) parameters, showing mean PURR initial values of 39.1 cm H2O and mean PURR curvature values of 0.17 cm H2O (mil/sec)2. The mean postvoiding urine was 37.5 ml. We diagnosed entero-ureteral reflux in 25% of patients and upper urinary tract dilatation due to a distal ureteral stricture in 2 patients. Mild outlet obstruction was diagnosed in 50% of the cases and were submitted to endoscopic section of the entero-urethral anastomosis. CONCLUSIONS: The distal sigmoid detubularized neobladder achieves a high rate of daytime continence with adequate frequency. However, the night-time incontinence rate was also high. The neobladder functional capacity remained stable throughout follow-up. Voiding was obtained as a result of neobladder contraction; thus postvoiding urine was minimal and patients did not require self-catheterization.

[Simplified Ramírez urethropexy in the treatment of genuine stress urinary incontinence in women. Multicenter study of clinical and urodynamic results]. / Uretropexia simplificada de Ramírez en el tratamiento de la incontinencia urinaria de esfuerzo genuina en la mujer. Estudio multicéntrico sobre los resultados clínicos y urodinámicos.

OBJECTIVES: To evaluate the clinical and urodynamic data of a multicenter study on female urinary stress incontinence undergoing surgical repair with the Ramírez simplified urethropexy. METHODS: Clinical, urodynamic and videocystographic data were analyzed in a multicenter series of 340 female patients with urinary stress incontinence (mean age 51.7 +/- 9.7 years) before and after the Ramírez urethropexy technique (mean follow-up 21.7 months). RESULTS: Post surgical urinary continence was 78.4%. Cystocele repair was demonstrated in 57.7%. Urge incontinence decreased in 17.1%. Daytime frequency statistically significantly decreased in 19%. Urinary obstructive symptoms increased in 19.3%. Bladder instability significantly decreased posturethropexy. Peak urinary flow rate and mean urinary flow rate diminished in 65% and 59%, respectively. Postvoiding residual urine increased significantly. No statistical correlation between posturethropexy continence and videocystographic bladder neck morphology was observed. CONCLUSIONS: The clinical and urodynamic data obtained in our series indicate that the Ramírez urethropexy technique, a simple and fast procedure, may be considered an alternative treatment in female urinary stress incontinence.

[Ureteral replacement with appendix]. / Sustitución ureteral con apéndice.

OBJECTIVE: The scant references in the literature on the use of the appendix in ureteral substitution prompted us to describe the present case in whom this technique was utilized. METHODS: The surgical technique of appendiceal interposition to repair a defect approximately 10 cm long in the right ureter is described. Following excision of a mass arising from the adnexa that entrapped the ureter at the level of the pelvis, the defect was repaired with the appendix. RESULTS: At two years follow-up, the patient is well and right excretory system function is normal. CONCLUSION: Ureteral repair with the appendix is simple and easy to perform. However, the indications for appendiceal interposition are more limited than those of the classical surgical techniques.

[Distal detubularized sigmoidoplasty. Description of the technique]. / La sigmoidoplastia distal destubulizada. Descripción de la técnica.

OBJECTIVES: To describe a new technique for orthotopic bladder replacement using a short detubularized segment of the most distal portion of the sigmoid colon, termed "detubularized distal sigmoidoplasty'. METHODS: The surgical technique utilized 1) large bowel to provide a larger intestinal lumen, stronger muscle layer and minimum metabolic activity; 2) a short segment providing adequate volume in the sigmoid and a reduced surface of exchange; and 3) a distal segment close to the urethra so it can be easily advanced without stretching and with minimum sectioning of the mesosigmoid. A short segment (approximately 18 cms) of the distal sigmoid is separated with minimum mobilization of the mesentery. It is detubularized to obtain a centrally located rectangle. The ureter is reattached using the antireflux technique of direct retrograde submucosal tunneling with a symmetrical pseudotrigonal arrangement. The reservoir is constructed using a single transverse continuous suture that is interrupted 2 cms before complete closure of the neobladder to provide an orifice for urethral anastomosis. RESULTS: The technique is simple and utilizes a segment shorter than those described to date. Any segment of the sigmoid can be utilized. The neobladder can be shaped with a single continuous suture and the ureter can be reinserted in a more anatomic position. The reservoir has an adequate volume of approximately 300 cc. Voiding is accomplished by contraction of the reservoir and abdominal pressure. CONCLUSIONS: This neobladder technique is simple. It achieves excellent diurnal continence and maintains the contractile capacity which permits comfortable and compensated voiding.

[Non-coordinated voiding syndrome: classification and urodynamic characterization]. / Síndrome de micción no coordinada: clasificación y caracterización urodinámica.

OBJECTIVES: To determine the urodynamic characteristics of uncoordinated voiding. METHODS: Fifty consecutive patients with a diagnosis of uncoordinated voiding were studied; 82% were females and 18% were males; mean age 11.9 years (range 5 to 34 yrs). All patients had a complete urodynamic study including patient history, neurological evaluation, uroflowmetry, cystometry and detrusor pressure/voiding flow. The perineal electromyographic (EMG) activity was recorded throughout the study using surface electrodes. To rule out neurogenic detrusor-sphincter dyssynergy, periurethral sphincter EMG using concentric nail-electrodes was performed in selected cases (20% of the patients). Based on our urodynamic findings, three subtypes of uncoordinated voiding can be distinguished: Type A: micturition is achieved through detrusor involuntary contraction. Type B: micturition is achieved through detrusor voluntary contraction. Type C: micturition is achieved through abdominal straining. RESULTS/CONCLUSIONS: The most important urodynamic findings in uncoordinated voiding, independently of Q max, were the absence of relaxation and increased perineal EMG activity during uroflowmetry. The detrusor pressure/voiding flow test was essential in the classification of uncoordinated voiding. In our series, 58% of the patients were type A, 28% type B and 14% type C.

[Inverted transitional-cell papilloma: the expression of the Ki-67 nuclear antigen as a prognostic factor]. / Papiloma invertido transicional: expresión del antígeno nuclear Ki-67 como factor pronóstico.

OBJECTIVE: This study attempted to correlate the clinical course and outcome of transitional cell inverted papilloma and the number of active cell nuclei, using Ki-67 antigen expression to quantify nuclear activity. METHODS: We analyzed thirteen pathologically confirmed lesions of transitional epithelial inverted papilloma in 12 patients that had been treated from 1977-1994. Immunohistochemical labelling of the tumor was performed using Mib-1 antibodies (a marker for the Ki-67 cell proliferation-associated cyclin) that identify active cell nuclei. Then we counted the number of active nuclei per 10 fields at high magnification (400x). RESULTS: The tumor was localized to the bladder in 11 cases and one case had 3 concomitant lesions in the renal pelvis. Five cases were associated with low grade urothelial transitional cell carcinoma, which was concomitant in one and asynchronous in the remaining 4 cases. One patient with inverted papilloma recurred and subsequently developed low grade transitional cell carcinoma. The elevated number of nuclei in the proliferative phase (more than 100 active nuclei per 10 high power fields) did not show a consistent correlation with good outcome. CONCLUSIONS: Treatment of inverted papilloma should be as in superficial transitional cell papillary carcinoma, since this tumor type may recur or be associated with transitional cell carcinoma. The lesions with a high proliferative activity, which is easily determined by Ki-67 antigen quantification, generally have a poor outcome.

[Perineal radical prostatectomy in the age of laparoscopy]. / La prostatectomía radical perineal en la era de la laparoscopia.

With the advent of laparoscopic lymphadenectomy, attention has been focussed again to the perineal approach for cancer of the prostate. The high rate of postoperative impotence and the abdominal incision required had made radical perineal prostatectomy unpopular. From August 1990 to July 1991, 76 patients with localized prostate cancer were surgically treated at the University of St. Louis. These patients were divided into three groups; group A comprised 26 patients who were submitted to laparoscopic lymphadenectomy and radical perineal prostatectomy, group B comprised patients treated by laparoscopic lymphadenectomy and radical retropubic prostatectomy, and group C or controls underwent open lymphadenectomy and radical retropubic prostatectomy. Fifty-three patients were sexually potent preoperatively but only 20 (7 from group A, 5 from group B and 8 from group C) were considered for preservation of the neurovascular bands. All the patients were followed for a minimum of one year. Comparison of these three groups revealed significant differences for perioperative bleeding and postoperative hospital stay in favor of Group A. The overall stress incontinence rate was 5.3% and the complications ranged from 4.1% for group C and 29.1% for group B. The postoperative sexual potency ranged from 57% for group A to 75% for group C, the differences not being statistically significant. Radical perineal prostatectomy is as valid as radical retropubic prostatectomy for localized prostatic cancer and has the advantages of less bleeding and a faster recovery, particularly if combined with laparoscopic lymphadenectomy.

[Pelvic fibromatosis: a case with clinical urologic features]. / Fibromatosis pelviana: un caso con clínica urológica.

We report on a patient with chronic prostate disease diagnosed as having a pelvic desmoid tumor (abdominal fibromatosis localized to the pelvis) whose presenting features were those of complete acute urinary retention. The findings on initial examination led us to suspect a prostate neoplasm which, however, was discarded by the results of the radiographic work up. The clinical and pathologic findings are presented and attention is drawn to the possibility that these mesenchymal neoplasms can have urological presenting symptoms and signs.