Goya y su sintomatología miccional de Burdeos, 1825 / Goya and his lower urinary tract symptoms in Bordeaux, 1825

El célebre pintor don Francisco de Goya y Lucientes (1746-1828) padeció a lo largo de su vida una o varias enfermedades cuya naturaleza no ha sido determinada con seguridad. Los episodios mórbidos, parcialmente documentados, correspondientes a los años 1792-1793, acontecidos en Sevilla y Cádiz; 1819, en Madrid, y 1825, en Burdeos, pudieran estar relacionados entre sí. En éste último, los signos y síntomas urológicos que el ilustre enfermó presentó sí han quedado acreditados. El objetivo del presente trabajo es proponer, recurriendo al material que no es otro que el «Diplomatario de Goya», con las cartas y documentos que hasta la fecha han sido coleccionados y dados a conocer, pretendiendo observar un método inductivo-deductivo en su estudio e interpretación e interrelacionando estas valiosas fuentes tanto con los conocimientos médicos de la época como los contemporáneos, particularmente en lo que a sus aspectos urológicos se refiere, y revisando la bibliografía disponible al respecto, con las naturales reservas de un pronunciamiento diagnóstico retrospectivo que por tanto, por sus inherentes características, no puede ser de total certidumbre, la hipótesis de la tabes dorsal neurosifilítica como responsable de los trastornos miccionales que se le presentaron en Burdeos en la primavera de 1825. Igualmente, y de manera complementaria, se incluye un breve repaso de algunas de las circunstancias y personajes que rodearon al artista en Francia para ayudar a incardinar y comprender mejor la personalidad de Goya, ya por entonces anciano y enfermo (AU)

The famous painter Francisco de Goya y Lucientes (1746-1828) suffered during his life one or several diseases, the nature of which has not been determined with certainty. The partially documented morbid episodes that happened during the years 1792-1793 in Seville and Cadiz, 1819 in Madrid, and 1825 in Bordeaux could be related. In the latter one, the urological signs and symptoms the distinguished patient presented have been demonstrated. The objective of this paper is to propose the hypothesis of neurosyphilis' dorsal tabes responsible for the voiding disorders he presented in Bordeaux in the spring of 1825, having as a resource Goya's «diplomatario», with the letters and documents that have been collected and made known to date, with the purpose of using an inductive-deductive method for their study and interpretation, setting an interrelation between these valuable sources with both the medical knowledge of the period and the current, particularly in urological features, and reviewing the available bibliography on that topic, with the natural reserve about giving a retrospective diagnosis which cannot be completely true due to its inherent characteristics. In the same way, and as a complement, we include a brief review of some circumstances and characters that surrounded the artist in France to help to incardinate and better understand the personality of Goya, already old and sick at that time (AU)

Investigations on urinary bladder reinnervation. Historical perspective and review.

Although nerve crossover surgery to bypass a spinal cord lesion and recentralize the decentralized bladder was first conceptualized in 1907, surprisingly few studies concerning this goal have been reported since. In addition to direct implantation of nerves into the detrusor, the studies reviewed have investigated the crossover of mixed roots (with and without nerve grafts), dorsal roots, ventral roots, pelvic, obturator and hypogastric nerves both in animal models, in human cadavers, and in human patients. Restoration of the micturition reflex through the use of nonsacral nerves has been achieved in cats. In addition, we have shown that the axons of a suprasacral mixed root (L7) when anastomosed to a sacral mixed root (S1) via a nerve graft can regenerate and recentralize the unilaterally decentralized bladder in the cat. The return of the micturition reflex after reconstruction of severed pelvic nerves has been documented, while the results of obstruction or hypogastric crossover have given diminished returns of bladder function. The direct implantation of nerves into the detrusor has not resulted in restoration of function. In addition, return of useful bladder function in humans after nerve crossover surgery has not been predictable. In part, present inability to achieve restoration of urinary bladder function may be a consequence of the complexity of micturition reflex organization and the inability to use techniques in humans that have given success in animals. Although, some of the technical aspects of nerve crossover surgery to bypass a spinal cord injury and restore functional micturition in those with neurogenic bladder dysfunction have been elucidated, further work is required to develop techniques that will enhance appropriate axonal regeneration to achieve reinnervation and return of useful function. Indeed, restoration of function may be limited by current microsurgical methodologies. Studies directed at understanding the neuropathophysiology of nerve injury and nerve surgery may be more fruitful in identifying factors than can be manipulated to achieve consistent return of useful function. In general, however, the results of the animal and human studies surveyed may be viewed with cautious optimism.

Enterocistoplastias en vejigas neurogénicas: nuestra evolución histórica / Enterocystoplasties on neurogenic bladders: our historical evolution

Se presentan 9 casos de enterocistoplastias efectuadas en vejiga neurogénica con el fin de creare un reservorio de baja presión susceptible de ser vaciado mediante autocateterismo. Se analiza, en orden cronológico, el cambio en la técnica quirúrgica como consecuencia del conocimiento actual del comportamiento del intestino detubularizado. Los resultados de continencia y cistomanometría post-operatoria demuestran las ventajas del uso de intestino detubularizado