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Objetivos: Evaluar la implantación de la enucleación con láser de holmio en nuestro centro incluyendo la curva de aprendizaje de un cirujano mediante el análisis de los pacientes tratados por este método. Material y métodos: Se analizaron 150 procedimientos de manera retrospectiva con un seguimiento medio de 11 meses. Se determinaron preoperatoriamente, así como a los 6 y a los 12 meses, los valores de Q max, IPSS y Qol realizando su análisis estadístico. El PSA fue medido preoperatoriamente, así como a los 3 meses de la cirugía. Se analizaron las complicaciones, así como el tiempo quirúrgico y el tiempo de ingreso hospitalario. Resultados: La edad media de los pacientes fue de 72,4 años. El tamaño prostático medio fue de 71,3g (18–150 g). Las horas medias de ingreso fueron 22. Los datos de Q max preoperatoria a los 6 y a los 12 meses fueron de 7,53, 23,24 y 21,62ml/s, siendo estadísticamente significativa (p<0,01). La tasa de transfusión fue del 1,3% y la de estenosis de la uretra del 4%. La mejoría del IPSS a los 6 y a los 12 meses también obtuvo significación estadística (p<0,01). Conclusiones: La enucleación con láser de holmio es una técnica segura y eficaz con una tasa de complicaciones inferior a la resección transuretral de próstata, incluso durante la curva de aprendizaje (AU)

Objectives: Evaluate the introduction of the enucleation with Holmium laser in our center, including the surgeon's learning curve by the analysis of the patients. Materials and methods: 150 procedures have been analyzed in a retrospective manner with an average follow-up of 11 months. Qmax, IPSS and Qol have been determined before surgery, at 6 months and 12 months, realizing their statistic analysis. PSA was measured before surgery and after 3 months. Complications, surgical time and hospital stay have been analyzed. Results: Average patient age was 72, 4 years. Average prostatic size was of 71,3gr (18–150). Average hospital stay was of 22h. Qmax before surgery, 6 months, 12 months was of 7,53ml/s, 23,24ml/s and 21,62ml/s being statistically significant (p<0,01). Transfusion rate was of 1,3% and urethral stenosis rate of 4%. IPSS improvement at 6 and 12 months was statistically significant as well (p<0, 01). Conclusions: Enucleation with Holmium laser is a safe and effective technique with lower complication rate than TURP, included during the learning curve (AU)

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OBJECTIVES: Evaluate the introduction of the enucleation with Holmium laser in our center, including the surgeon's learning curve by the analysis of the patients. MATERIALS AND METHODS: 150 procedures have been analyzed in a retrospective manner with an average follow-up of 11 months. Qmax, IPSS and Qol have been determined before surgery, at 6 months and 12 months, realizing their statistic analysis. PSA was measured before surgery and after 3 months. Complications, surgical time and hospital stay have been analyzed. RESULTS: Average patient age was 72, 4 years. Average prostatic size was of 71,3 gr (18-150). Average hospital stay was of 22 h. Qmax before surgery, 6 months, 12 months was of 7,53 ml/s, 23,24 ml/s and 21,62 ml/s being statistically significant (p<0,01). Transfusion rate was of 1,3% and urethral stenosis rate of 4%. IPSS improvement at 6 and 12 months was statistically significant as well (p<0, 01). CONCLUSIONS: Enucleation with Holmium laser is a safe and effective technique with lower complication rate than TURP, included during the learning curve.

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BACKGROUND: The low probability of curing high-risk prostate cancer (PC) with local therapy suggests the need to study modality of therapeutic approaches. To this end, a prospective phase II trial of neoadjuvant docetaxel (D) and complete androgen blockade (CAB) was carried out in high-risk PC patients. The primary end point was to detect at least 10% of pCRs after chemohormonal treatment. METHODS: Patients with T1c-T2 clinical stage with prostate-specific antigen (PSA) >20 ng ml(-1) and/or Gleason score >or=7 (4+3) and T3 were included. Treatment consisted of three cycles of D 36 mg m(-2) on days 1, 8 and 15 every 28 days concomitant with CAB, followed by radical prostatectomy (RP). RESULTS: A total of 57 patients were included. Clinical stage was T1c, 11 patients (19.3%); T2, 30 (52.6%) and T3, 16 (28%) patients. Gleason score was >or=7 (4+3) in 44 (77%) patients and PSA >20 ng ml(-1) in 15 (26%) patients. Treatment was well tolerated with 51 (89.9%) patients completing neoadjuvant therapy together with RP. The rate of pCR was 6% (three patients). Three (6%) additional patients had microscopic residual tumour (near pCR) in prostate specimen. With a median follow-up of 35 months, 18 (31.6%) patients presented PSA relapse. CONCLUSION: Short-term neoadjuvant D and CAB induced a 6% pCR rate, which is close to what would be expected with ADT alone. The combination was generally well tolerated.

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BACKGROUND: Mitoxantrone/prednisone ameliorates symptoms in hormone refractory prostate cancer (HRPC) but has no effect on survival. Docetaxel (Taxotere)/estramustine improves response but with significant toxicity. We reasoned that a sequential administration of the two regimens could be a viable alternative for delivering full doses of chemotherapy, avoiding overlapping toxicity and preserving dose intensity. PATIENTS AND METHODS: Thirty HRPC patients were treated with mitoxantrone 10 mg/m(2), day 1, every 3 weeks, plus prednisone 5 mg twice daily, for three cycles, followed by estramustine phosphate, 280 mg three times daily, days 1 to 5, plus docetaxel 75 mg/m(2), day 2, every 3 weeks for a maximum of 10 cycles. RESULTS: All patients were assessable for response and toxicity. After mitoxantrone/prednisone treatment, the prostate-specific antigen (PSA) response rate was 23%, which increased to 63% after completion of sequential mitoxantrone/prednisone and docetaxel/estramustine treatment (12 partial and 7 complete responses). With a median follow-up of 18 months, median survival for all patients was 18 months, and median progression-free survival was 10 months. The mitoxantrone/prednisone regimen was well tolerated, and the only grade 3-4 toxicity was grade 3 neutropenia in four (13%) patients. Twenty-nine patients received a total of 173 cycles of docetaxel/estramustine (median, 6 cycles/patient). Six (20%) patients had grade 3-4 neutropenia and two (6%) patients had febrile neutropenia episodes. The most frequent non-hematological toxic effects were asthenia, nausea and vomiting, edemas and onycholysis. Two (6%) patients had deep venous thrombosis. CONCLUSIONS: Mitoxantrone/prednisone followed by docetaxel/estramustine is a well-tolerated and active regimen in HRPC. Sequential therapy is feasible and can be used to integrate novel, more active regimens.

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Removing very fine particles in the 0.01-1 micro m range generated in diesel combustion is important for air pollution abatement because of the impact such particles have on the environment. By forming larger particles, acoustic agglomeration of submicron particles is presented as a promising process for enhancing the efficiency of the current filtration systems for particle removal. Nevertheless, some authors have pointed out that acoustic agglomeration is much more efficient for larger particles than for smaller particles. This paper studies the effect of humidity on the acoustic agglomeration of diesel exhausts particles in the nanometer size range at 21 kHz. For the agglomeration tests, the experimental facility basically consists of a pilot scale plant with a diesel engine, an ultrasonic agglomeration chamber a dilution system, a nozzle atomizer, and an aerosol sampling and measuring station. The effect of the ultrasonic treatment, generated by a linear array of four high-power stepped-plate transducers on fumes at flow rates of 900 Nm(3)/h, was a small reduction in the number concentration of particles at the outlet of the chamber. However, the presence of humidity raised the agglomeration rate by decreasing the number particle concentration by up to 56%. A numerical study of the agglomeration process as a linear combination of the orthokinetic and hydrodynamic agglomeration coefficients resulting from mutual radiation pressure also found that acoustic agglomeration was enhanced by humidity. Both results confirm the benefit of using high-power ultrasound together with humidity to enhance the agglomeration of particles much smaller than 1 micro m.

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Se describe un brote de escabiosis aparecido en la Unidad de hospitalización de Aparato Respiratorio de un hospital de 500 camas iniciado al ingresar una paciente de 90 años procedente de una residencia geriátrica. Se produjeron 27 casos secundarios entre personal sanitario (14) y pacientes (13), y otros 7 altamente probables entre 198 contactos. Se trataron con crema de permetrina al 5 por ciento en tres aplicaciones separadas una semana entre sí. También se empleó como profilaxis en no afectados en aplicación única. Se debaten las recomendaciones médico-preventivas para controlar la propagación de estos procesos. (AU)

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A scabies outbreak is reported which appeared in the Inpatient Pneumology Department in a 500-bed hospital. The outbreak began after the admission of a 90-year old woman referred from a nursing home. A total of 27 secondary cases occurred among health care personnel (14) and patients (13); other 7 cases of likely scabies occurred among 198 contacts. Patients were treated with 5% permetrine cream, in three applications one week apart from each other. It was also applied as prophylaxis in non involved patients in a single application. A discussion follows on the medical and preventive recommendations to control the spreading of these outbreak.

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We make here a preliminary report of the first 65 cases of tularemia diagnosed at our hospital pertaining to an epidemic outbreak occurred in the area served by the hospital. Diagnosis was made by the presence of a consistent clinical picture and the following laboratory criteria: antibody titre to. Francisella tularensis (tube agglutination) higher than or equal to 1/160, seroconversion or recovery of the microorganism from biological material. The mean age of our patients was 53.8 +/- 13.5 years and female sex predominated (45 women). Fever, lymph node enlargement, cutaneous ulcers, asthenia, and weight loss were the most common symptoms. The presentation clinical forms included: ulceroganglionar (69%), typhoidal (14%), ganglionar (12.5%), pneumonic (1.5%), oculoganglionar (1.5%) and atypical (1.5%). The analytical data did not show significant changes with the exception of erythrocyte sedimentation rate. Streptomycin was the antibiotic of choice, followed by ciprofloxacin and gentamicin. The failure rate was 22%, and ciprofloxacin was used for retreatment in twelve occasions and ofloxacin in 1 occasion with a good response. Tularemia is an infective disease which can become endemic in Spain and that should be considered by clinicians, particularly when unilateral enlarged lymph nodes, prolonged febrile syndromes, pharyngitis with negative culture, poor response to beta-lactams and atypical pneumonia are present.

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