RESUMEN
OBJECTIVE: To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type of components of ERAS play a key role on the decrease of surgical morbidity. MATERIALS AND METHODS: We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate. RESULTS: Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (p < 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%, p = 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively, p = 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted [RR = 0.815; 95% confidence interval (CI) 0.667-0.996; p = 0.045]. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications. CONCLUSIONS: Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS.
Asunto(s)
Cistectomía , Recuperación Mejorada Después de la Cirugía , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Cistectomía/métodos , Femenino , Adhesión a Directriz , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Resultado del TratamientoRESUMEN
AIM: The selectivity of a water jet (WJ) is already used with clinical advantage in the surgery of liver, brain, kidney and herniated lumbar discs. The aim of the present study was to determine whether a WJ can be used for synovectomy without damaging the joint capsule and the cartilage. METHOD: 60 human cadaver knee specimens (67 +/- 14 years) were dissected into synovial and cartilage samples. They were randomly assessed to four pressure groups (pW = 3; 6; 9; 12 MPa) and three jet surface angles (beta = 30; 60; 90 degrees) The nozzle diameter was dD = 0.12 mm, the stand off distance of the jet was s = 10 mm with a feed rate of vV = 2 mm/s. The acquired parameters were depth of the cuts, histological layer, and change of the samples thickness. RESULT: There was a correlation of the cutting depth and the pressure (pW), whereas the jet-surface angle (beta) showed no correlation. The synovial layer of the cut likewise correlated with the pressure. At pW = 6 MPa the stratum subsynoviale could be cut selectively without damaging the fibrous capsule or the cartilage. The increase of the samples thickness was caused by an interstitial oedema. CONCLUSION: The different mechanical properties of the joint capsule and the stratum subsynoviale lead to the selective cutting of the water jet. Since the joint capsule was not damaged, the feasibility of WJ synovectomy has been proven. The device can be used for synovectomy in parts of the joint that are not visible as well as in very small joints.
Asunto(s)
Procedimientos Ortopédicos/instrumentación , Sinovectomía , Anciano , Cartílago Articular/patología , Diseño de Equipo , Estudios de Factibilidad , Femenino , Humanos , Presión Hidrostática , Técnicas In Vitro , Cápsula Articular/patología , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Membrana Sinovial/patologíaRESUMEN
The internet has opened a new social space for communication. The present work studies interpersonal relationships in cyberspace using the chat channel as an interaction medium. Data obtained have outlined the sociodemographic and personality profile of internet users who engage in online chats as well as group self-perception, chatters' use habits, motivations to interact online, and the chatters' network of virtual and face-to-face relationships. Results suggests that relationships developed online are healthy and a complement to face-to-face relationships. These data are confirmed by personality studies. The theoretical and methodological implications of data are discussed.
Asunto(s)
Comunicación , Internet , Relaciones Interpersonales , Conducta Social , Interfaz Usuario-Computador , Adulto , Femenino , Hábitos , Humanos , Masculino , Motivación , Determinación de la Personalidad , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/epidemiología , AutoimagenRESUMEN
The present study investigated inflammation-induced changes in adrenergic regulation of smooth muscle. Colitis was induced in rats by intrarectal administration of trinitrobenzenesulfonic acid in ethanol. After 4 h (acute) or 7 days (chronic), in vitro isometric tension was measured in strips of circular smooth muscle taken from the distal colon. In controls, the major inhibitory control of smooth muscle responses to nerve stimulation was mediated by nitric oxide and beta adrenergic receptors. There was less evidence of alpha adrenergic control. Studies with the beta3 receptor antagonist cyanopindolol and the beta3 receptor agonist BRL37344 revealed that beta adrenergic regulation of spontaneous contractions and responses to nerve stimulation were mediated primarily by the beta3 adrenoreceptor. Both acute and chronic colitis significantly increased responses to electrical field stimulation. This effect was attributed to a loss of inhibitory nitrergic regulation as well as to selective changes in the beta adrenergic control of colonic circular smooth muscle. Inflammation did not alter alpha adrenergic control. Chronic colitis also decreased the sensitivity to nerve stimulation and pharmacological contractile agents. Acute and chronic inflammation reduced the ability of BRL37344 to inhibit contractions in response to nerve stimulation. In addition, in inflamed colon, BRL37344 was less effective in relaxing carbachol-induced precontractions. Finally, inflammation resulted in a loss of the ability of the cyanopindolol to increase the amplitude of both spontaneous contractions and contractions in response to nerve stimulation. These effects indicated that colitis induced a down-regulation of inhibitory beta3 adrenergic control of colonic smooth muscle function. This loss of adrenergic regulation may contribute to the diarrhea in inflammatory bowel disease.
Asunto(s)
Colitis/fisiopatología , Músculo Liso/inervación , Músculo Liso/fisiopatología , Sistema Nervioso Simpático/fisiopatología , Agonistas Adrenérgicos/farmacología , Antagonistas Adrenérgicos/farmacología , Animales , Carbacol/farmacología , Colitis/patología , Progresión de la Enfermedad , Estimulación Eléctrica , Técnicas In Vitro , Masculino , Contracción Muscular/efectos de los fármacos , Músculo Liso/patología , Parasimpaticomiméticos/farmacología , Ratas , Ratas Sprague-Dawley , Receptores Adrenérgicos/efectos de los fármacos , Receptores Adrenérgicos/fisiología , Sistema Nervioso Simpático/patologíaRESUMEN
IL-4 and IL-13 promote gastrointestinal worm expulsion, at least in part, through effects on nonlymphoid cells, such as intestinal epithelial cells. The role of IL-4/IL-13 in the regulation of intestinal epithelial function during Heligmosomoides polygyrus (Hp) infection was investigated in BALB/c mice infected with Hp or treated with a long-lasting formulation of recombinant mouse IL-4/alphaIL-4 complexes (IL-4C) for 7 days. Separate groups of BALB/c mice were drug-cured of initial infection and later reinfected and treated with anti-IL-4R mAb, an antagonist of IL-4 and IL-13 receptor binding, or with a control mAb. Segments of jejunum were mounted in Ussing chambers, and short circuit current responses to acetylcholine, histamine, serotonin, PGE2, and glucose were determined. Although only modest changes in epithelial cell function were observed during primary Hp infection, IL-4C or a secondary Hp infection each induced more dramatic changes, including increased mucosal permeability, reduced sodium-linked glucose absorption, and increased Cl- secretory response to PGE2. Some, but not all, effects of IL-4C and Hp infection were dependent on enteric nerves. Hp-induced changes in epithelial function were attenuated or prevented by anti-IL-4R mAb. Thus, IL-4/IL-13 mediate many of the effects of Hp infection on intestinal epithelial cell function and do so both through direct effects on epithelial cells and through indirect, enteric nerve-mediated prosecretory effects. These immune system-independent effector functions of IL-4/IL-13 may be important for host protection against gastrointestinal nematodes.
Asunto(s)
Heligmosomatoidea/inmunología , Interleucina-4/fisiología , Mucosa Intestinal/inmunología , Mucosa Intestinal/parasitología , Animales , Anticuerpos Bloqueadores/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Dinoprostona/farmacología , Femenino , Histamina/farmacología , Interleucina-13/antagonistas & inhibidores , Interleucina-13/biosíntesis , Interleucina-4/antagonistas & inhibidores , Interleucina-4/biosíntesis , Parasitosis Intestinales/inmunología , Parasitosis Intestinales/patología , Mucosa Intestinal/citología , Mucosa Intestinal/inervación , Ratones , Ratones Endogámicos BALB C , Neuronas/inmunología , Receptores de Interleucina-4/inmunología , Receptores de Interleucina-4/fisiología , Infecciones por Strongylida/inmunología , Infecciones por Strongylida/patologíaRESUMEN
Achalasia in children bears many similarities to the disorder in adults, both in terms of clinical features and in terms of the approach to therapy. Pharmacologic management is of limited temporary benefit until more definitive therapy is undertaken. Intrasphincteric injections of botulinum toxin provides safe but short-term relief from symptoms. Based on our review of the safety and effectiveness of pneumatic dilation, we advocate this procedure as the primary form of definitive therapy for achalasia in children. In patients who do not achieve satisfactory results from a series of graduated pneumatic dilations, Heller myotomy provides safe and effective surgical treatment.
Asunto(s)
Acalasia del Esófago/etiología , Acalasia del Esófago/terapia , Adolescente , Factores de Edad , Toxinas Botulínicas Tipo A/uso terapéutico , Niño , Preescolar , Diagnóstico Diferencial , Dilatación , Acalasia del Esófago/diagnóstico , Acalasia del Esófago/epidemiología , Femenino , Humanos , Lactante , Masculino , Músculo Liso/cirugía , Fármacos Neuromusculares/uso terapéutico , Selección de Paciente , Pediatría/métodos , Seguridad , Resultado del TratamientoRESUMEN
In inflammatory bowel disease, smooth muscle function reportedly varies with disease duration. The aim of these studies was to determine changes in the control of spontaneous contractions in a model of experimental colitis that included reinflammation of the healed area. The amplitude and frequency of spontaneous contractions in circular smooth muscle were determined after intrarectal administration of trinitrobenzenesulfonic acid in rat distal colon. With the use of a novel paradigm, rats were studied 4 h (acute) or 28 days (healed) after the initial inflammation. At 28 days, rats were studied 4 h after a second inflammation (reinflamed) of the colon. Colitis induced transient increases in the amplitude of spontaneous contractions coincident with a loss of nitric oxide synthase activity. The frequency of contractions was controlled by constitutive nitric oxide in controls. Frequency was increased in healed and reinflamed colon and was associated with a shift in the dominance of neural constitutive nitric oxide synthase control to that of inducible nitric oxide synthase (iNOS). The initial colitis induced a remodeling of the neural control of spontaneous contractions reflecting changes in their regulation by constitutive nitric oxide synthase and iNOS.
Asunto(s)
Colitis/fisiopatología , Colon/fisiopatología , Inflamación/fisiopatología , Contracción Muscular/fisiología , Animales , Colitis/patología , Colon/efectos de los fármacos , Colon/patología , Modelos Animales de Enfermedad , Motilidad Gastrointestinal/fisiología , Guanidinas/farmacología , Técnicas In Vitro , Inflamación/patología , Enfermedades Inflamatorias del Intestino/patología , Enfermedades Inflamatorias del Intestino/fisiopatología , Masculino , Contracción Muscular/efectos de los fármacos , Músculo Liso/efectos de los fármacos , Músculo Liso/patología , Músculo Liso/fisiopatología , NADPH Deshidrogenasa/análisis , Óxido Nítrico Sintasa/metabolismo , Ratas , Ratas Sprague-Dawley , Tetrodotoxina/farmacología , Factores de Tiempo , Ácido Trinitrobencenosulfónico/toxicidad , omega-N-Metilarginina/farmacologíaRESUMEN
The present study was designed to investigate inflammation-induced changes in smooth muscle responses to acetylcholine and the tachykinins that may contribute to the abnormal motility associated with inflammatory bowel disease. Colitis was induced in male Sprague-Dawley rats by intrarectal administration of trinitrobenzenesulphonic acid in ethanol. After either 4 h (acute) or 7 days (chronic) the distal colon was taken for in vitro measurement of smooth muscle tension and histological assessment. Acute colitis featured injury and neutrophilic infiltration confined to the mucosa while chronic inflammation showed marked injury, lymphocytic infiltration and muscle thickening. Acute inflammation increased responses to substance P and acetylcholine but decreased responses to neurokinin A. The enhanced response to substance P was dependent on nerves, while the decreased response to neurokinin A reflected a reduction in activity at the level of the smooth muscle. In the saline group, there was evidence of cholinergic interaction with substance P, but not neurokinin A. Substance P modulation of cholinergic nerves was absent in acute inflammation. Responses to all neurotransmitters were decreased in the chronic stage. These data demonstrate progressive changes in the smooth muscle function during acute and chronic colitis that may contribute to the abnormal motility associated with inflammatory bowel disease.
Asunto(s)
Colitis/fisiopatología , Motilidad Gastrointestinal/fisiología , Contracción Muscular/fisiología , Músculo Liso/fisiología , Acetilcolina/farmacología , Animales , Atropina/farmacología , Colitis/inducido químicamente , Relación Dosis-Respuesta a Droga , Motilidad Gastrointestinal/efectos de los fármacos , Hexametonio/farmacología , Masculino , Contracción Muscular/efectos de los fármacos , Neuroquinina A/farmacología , Antagonistas Nicotínicos/farmacología , Parasimpatolíticos/farmacología , Cloruro de Potasio/farmacología , Ratas , Ratas Sprague-Dawley , Sustancia P/farmacología , Tetrodotoxina/farmacología , Ácido Trinitrobencenosulfónico , Vasodilatadores/farmacologíaRESUMEN
Previous electrophysiological studies have shown that tachykinin-mediated excitatory junction potentials are enhanced in a ricin model of inflammatory bowel disease. The present study extends these findings by investigating the contractile response to stimulation of noncholinergic nerves and tachykinin agonists. According to rank order potencies, the rabbit ileal circular muscle was neurokinin (NK)1 preferring, and the response to these agonists was down-regulated by acetylcholine and up-regulated by nitric oxide. In ricin-treated tissue, cholinergic and nitridergic modulation was lost; in the presence of atropine and N-nitro-L-arginine methyl ester, or tetrodotoxin, the response to NK1 and NK2 agonists was enhanced. The noncholinergic response to nerve stimulation was predominantly mediated by NK1 receptors, and the enhanced response of ricin-treated tissue to NK1 agonists probably contributes to the increased response to electrical field stimulation observed under these conditions. Increased tachykinin response and loss of control of this response by acetylcholine and nitric oxide are likely to have profound effects on intestinal motility and could contribute to some of the symptomology of inflammatory bowel disease.
Asunto(s)
Ileítis/fisiopatología , Transmisión Sináptica , Taquicininas/farmacología , Acetilcolina/farmacología , Animales , Relación Dosis-Respuesta a Droga , Técnicas In Vitro , Masculino , Contracción Muscular/efectos de los fármacos , Conejos , Ricina/farmacologíaRESUMEN
The role of sensory afferents in inflammation-induced alterations in myoelectric activity in vivo was investigated in the rabbit small intestine. Isolated ileal loops were implanted with serosal electrodes and exposed to ricin or vehicle after pretreatment with 125 mg/kg of subcutaneous (125 mg over 3 days) or intraluminal (640 microM) capsaicin. After 5 h of myoelectric recording, the loops were prepared for histology and for ex vivo generation of eicosanoids. Capsaicin exacerbated mucosal damage after exposure to ricin but did not alter neutrophil infiltration. Subcutaneous capsaicin alone elevated slow-wave frequency and spike events and transiently suppressed the myoelectric response to ricin. In contrast, intraluminal capsaicin alone did not alter myoelectric activity but produced a sustained inhibition of the response to ricin. Eicosanoid production was unchanged by capsaicin alone. Intraluminal capsaicin blocked increases in leukotriene C4 and prostaglandin E2 during inflammation, an effect that paralleled its inhibition of myoelectric activity. Thus the contribution of sensory afferents to altered motility during acute ileitis involves the release of mucosal inflammatory mediators that influence neural control of smooth muscle.
Asunto(s)
Ileítis/fisiopatología , Íleon/fisiopatología , Músculo Liso/fisiopatología , Neuronas Aferentes/fisiología , Enfermedad Aguda , Animales , Capsaicina/farmacología , Eicosanoides/biosíntesis , Electrofisiología , Ileítis/inducido químicamente , Ileítis/metabolismo , Íleon/metabolismo , Íleon/patología , Técnicas In Vitro , Masculino , Músculo Liso/metabolismo , Músculo Liso/patología , Conejos , RicinaAsunto(s)
Obstrucción Duodenal/etiología , Duodeno/patología , Enfermedades Gastrointestinales/complicaciones , Sarcoidosis/complicaciones , Abdomen/patología , Adolescente , Radioisótopos de Bario , Biopsia , Diagnóstico Diferencial , Obstrucción Duodenal/diagnóstico , Obstrucción Duodenal/patología , Duodeno/ultraestructura , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/patología , Humanos , Masculino , Sarcoidosis/diagnóstico , Sarcoidosis/patología , Tomografía Computarizada por Rayos XAsunto(s)
Epilepsia/fisiopatología , Parálisis/fisiopatología , Adulto , Epilepsia/diagnóstico , Parálisis Facial/diagnóstico , Parálisis Facial/fisiopatología , Lateralidad Funcional , Humanos , Imagen por Resonancia Magnética , Masculino , Parálisis/diagnóstico , Músculos Faríngeos/patología , Músculos Faríngeos/fisiopatología , SíndromeRESUMEN
Despite of prostate abscesses having become an uncommon disease, a number of cases has been described lately specially in immunodepressed patients caused by infrequent agents, such as Mycobacterium tuberculosis. This paper describes the case of one HIV-positive patient, diagnosed with a prostate abscess within a tuberculous dissemination. The best diagnostic method is considered to be the transrectal ultrasound (TRU), the choice therapy being drainage by ultrasound-guided transperineal percutaneous puncture.
Asunto(s)
Absceso/complicaciones , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Enfermedades de la Próstata/complicaciones , Tuberculosis de los Genitales Masculinos/complicaciones , Absceso/diagnóstico , Absceso/terapia , Adulto , Humanos , Masculino , Enfermedades de la Próstata/diagnóstico , Enfermedades de la Próstata/terapia , Tuberculosis de los Genitales Masculinos/diagnóstico , Tuberculosis de los Genitales Masculinos/terapiaAsunto(s)
Adopción , Hepatitis B/epidemiología , Hepatitis Crónica/epidemiología , Biopsia , Preescolar , Emigración e Inmigración , Femenino , Estudios de Seguimiento , Hepatitis B/complicaciones , Hepatitis B/inmunología , Hepatitis B/patología , Antígenos e de la Hepatitis B/sangre , Hepatitis Crónica/complicaciones , Hepatitis Crónica/inmunología , Hepatitis Crónica/patología , Humanos , Hígado/patología , Masculino , Prevalencia , Estudios Retrospectivos , Rumanía/epidemiología , Rumanía/etnología , Estados Unidos/epidemiologíaRESUMEN
The introduction of percutaneous occlusion techniques to manage a varicocele has made possible the control of the process with success rates similar to those obtained with conventional surgery. Its efficacy and minimal invasive nature, although not entirely risk-free, are responsible for its expansion. Contribution of one case of adhesion of the intravascular catheter to the underlying spermatic vein wall during infusion with isobutyl cyanoacrylate (bucrylate) as embolization material, an event which forced immediate surgical removal.
Asunto(s)
Bucrilato/administración & dosificación , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/instrumentación , Embolización Terapéutica/instrumentación , Varicocele/tratamiento farmacológico , Adulto , Bucrilato/uso terapéutico , Falla de Equipo , Humanos , Infusiones Intravenosas , MasculinoRESUMEN
Obstructive uropathy is the common presentation course for various processes with an origin either intraluminar, parietal or extraluminar. A retrospective analysis of 41 cases of extrinsically originated obstructive uropathy seen in our Urology Unit from 1976 to 1991 was carried out. The cases were divided in three groups following an exclusively etiological criterion: 21.9% (9 patients) corresponded to primary retroperitoneal fibrosis; 51.2% (21 patients) to tumoral ureteral obstruction; and 26.8% (11 patients) to non-tumoral processes. For each division established, the features of clinical presentation, performance of the various diagnostic procedures used, and different therapy approaches are described also including a review on the current literature.
Asunto(s)
Obstrucción Ureteral/etiología , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Obstrucción Ureteral/diagnóstico , Obstrucción Ureteral/terapiaRESUMEN
Within the scope of urogenital tract tumoral diseases, renal adenocarcinoma is the third most frequent neoplasia diagnosed in the adult population. The limited clinical presentations in early analysis and their anarchical behaviour are the cause for 50% to 60% of patients having already developed distant disease at the time of diagnosis. The only curative procedure so far is radical surgery, which is possible when there is a single metastatic site and sometimes even, depending on various factors which will be analyzed, several sites. In these occasions, the traditional therapeutic choices (Hormonotherapy, Chemotherapy, Radiotherapy) have proven to have limited or no efficacy in managing the disease. This fact, together with the successful results obtained in other tumoral processes, have allowed the clinical development of different modalities of Immunotherapy for the management of metastatic renal carcinoma, with results clearly hopeful. This work is a review of the results reported for each of the mentioned therapeutic choices, basically analyzing the role currently played by surgery and immunotherapy in the management of advanced renal carcinoma.
Asunto(s)
Neoplasias Renales/patología , Neoplasias Renales/terapia , Terapia Combinada , Femenino , Hormonas/uso terapéutico , Humanos , Inmunoterapia , Masculino , Invasividad Neoplásica , Metástasis de la Neoplasia , Estadificación de NeoplasiasRESUMEN
The myenteric plexus consists of several subpopulations of morphologically and chemically distinct neurons known to contain a variety of peptides and amines, one of which is serotonin (5-hydroxytryptamine). These neurons are considered essential for nerve-to-nerve transmission. In the present study, we investigated the effect of 5,6- and 5,7-dihydroxytryptamine (5,6-DHT; 5,7-DHT), indoleamine neurotoxins that selectively and irreversibly injure the serotonergic neurons of the myenteric plexus. Treatment with 5,6-, or 5,7-DHT caused marked disruption of the activity front of the migrating myoelectric complex (MMC), increased its duration, and decreased its propagation velocity. At higher doses, 5,7-DHT also reduced the slow-wave frequency. Immunohistochemical techniques showed that tissue from rats treated with 5,7-DHT was depleted of serotonin-like immunoreactivity within the myenteric plexus neurons. Reserpine also caused motility and immunohistochemical changes similar to those induced by the two neurotoxins. Therefore, destruction of enteric serotonergic neurons disrupts the MMC. These studies support the cellular concepts that serotonergic neurons function as interneurons in the myenteric plexus, modulating and processing the neural stimuli, and that serotonin is an important neurotransmitter in the small intestine.