RESUMEN
Objetivo: Realizar un análisis estadístico multivariante de factores epidemiológicos, clínicos y bioquímicos que permitan identificar las variables que independientemente puedan predecir la evolución de la litiasis renal, definiendo así un grupo de riesgo con peor evolución. Material y métodos: Estudio analítico, descriptivo, retrospectivo sobre 248 pacientes visitados en nuestro centro en el periodo 2003-2007. Se ha realizado análisis univariante (Chi-cuadrado) y multivariante (regresión logística) de posibles factores predictivos epidemiológicos (sexo, edad), clínicos (antecedentes personales de litiasis, número, localización caliciar y tamaño de cálculos, bilateralidad) y bioquímicos (bioquímica urinaria y composición del cálculo) en relación con la evolución de la litiasis renal (limpio o persistencia renal). Resultados: Con un seguimiento medio de 60 meses (IC 95%=52,5-67,4) observamos una persistencia global de litiasis renal en 121 pacientes (48,8%), estando limpios de litiasis 127 pacientes (51,2%). El análisis univariante describe como variables asociadas a mayor persistencia de litiasis la edad, el número de litiasis, la localización calicilar, la bilateralidad, la composición bioquímica urinaria y la composición bioquímica del cálculo; de todas estas variables, en el análisis multivariante solo mantienen significación estadística la edad inferior a 47 años, la bilateralidad, la localización calicilar y la composición química de la litiasis (oxalato cálcico dihidrado). Conclusiones: Existe una elevada persistencia de litiasis renal. La edad inferior a 47 años, la bilateralidad, la localización calicilar y la composición química de la litiasis (oxalato cálcico dihidrato) son factores asociados a mayor persistencia de litiasis renal de forma independiente. Estos factores señalan un grupo con peor evolución clínica, en los que deberíamos replantear estrategias diagnósticas y terapéuticas más individualizadas (AU)
Objective: To perform a multivariate statistical analysis of epidemiological, clinical and biochemical factors that make it possible to identify the variables that can independently predict the course of renal lithiasis, thus defining a group at risk of worse evolution. Material and methods: A retrospective, descriptive and analytic study was in a cohort of 248 patients with kidney stones treated in our center from 2003 to 2007. A univariate (chi-square) and multivariate analysis (regression model) of possible epidemiological predictive factors (age, gender), clinical data of stones (number, localization, size and bilaterality) and biochemical factors (urinary composition, stone composition) were analyzed. Results: Based on a mean follow-up of 60 months (95% CI: 52.5-67.4) we observed a global persistence of kidney stones in 121 patients (48.8%), 127 patients being stone-free (51.2%). The univariate analysis describes the following variables as being associated to greater persistence of lithiasis: age, number of stones, calyceal localization and bilaterality, urinary biochemical composition, and stone biochemical composition. In regards to all of the above variables, only age less than 47 years, bilaterality, stone localization and chemical composition of the lithiasis (oxalate calcium dehydrated) were significantly associated to a major risk of persistence of kidney stones. Conclusion: There is a high persistence rate of kidney stones. Patient age inferior to 47 year, calyceal localization, bilaterality, and biochemical composition of stones (oxalate calcium dihydrate) are independent factors associated to higher persistence rate of kidney stones. These factors indicate a risk group with a worse clinical prognosis in which we should reconsider more individualized diagnostic and therapeutic strategies (AU)
Asunto(s)
Humanos , Masculino , Femenino , Nefrolitiasis/epidemiología , Nefrolitiasis/prevención & control , Análisis Multivariante , Epidemiología Descriptiva , Pronóstico , Litiasis/químicaRESUMEN
OBJECTIVE: To perform a multivariate statistical analysis of epidemiological, clinical and biochemical factors that make it possible to identify the variables that can independently predict the course of renal lithiasis, thus defining a group at risk of worse evolution. MATERIAL AND METHODS: A retrospective, descriptive and analytic study was in a cohort of 248 patients with kidney stones treated in our center from 2003 to 2007. A univariate (chi-square) and multivariate analysis (regression model) of possible epidemiological predictive factors (age, gender), clinical data of stones (number, localization, size and bilaterality) and biochemical factors (urinary composition, stone composition) were analyzed. RESULTS: Based on a mean follow-up of 60 months (95% CI: 52.5-67.4) we observed a global persistence of kidney stones in 121 patients (48.8%), 127 patients being stone-free (51.2%). The univariate analysis describes the following variables as being associated to greater persistence of lithiasis: age, number of stones, calyceal localization and bilaterality, urinary biochemical composition, and stone biochemical composition. In regards to all of the above variables, only age less than 47 years, bilaterality, stone localization and chemical composition of the lithiasis (oxalate calcium dehydrated) were significantly associated to a major risk of persistence of kidney stones. CONCLUSION: There is a high persistence rate of kidney stones. Patient age inferior to 47 year, calyceal localization, bilaterality, and biochemical composition of stones (oxalate calcium dihydrate) are independent factors associated to higher persistence rate of kidney stones. These factors indicate a risk group with a worse clinical prognosis in which we should reconsider more individualized diagnostic and therapeutic strategies.
Asunto(s)
Nefrolitiasis , Adulto , Femenino , Humanos , Masculino , Análisis Multivariante , Nefrolitiasis/diagnóstico , Nefrolitiasis/epidemiología , Nefrolitiasis/metabolismo , Pronóstico , Estudios RetrospectivosRESUMEN
Objetivo: conocer la incidencia de la estenosis de la anastomosis vesicouretral en pacientes con cáncer de próstata tratados con prostatectomía radical. El objetivo secundario fue analizar si la radioterapia postoperatoria incrementa el riesgo de presentar una estenosis de la anastomosis. Material y métodos: se revisaron retrospectivamente las historias de los pacientes sometidos a prostatectomía radical como tratamiento primario entre enero 2000 y diciembre del 2008, con un seguimiento clínico mínimo de 12 meses. Del total de pacientes 258 cumplían los requisitos anteriores. De ellos 25 (9,6%) recibieron radioterapia postoperatoria, 12 (48%) de forma adyuvante y 13 (52%) de rescate. La edad media de los pacientes irradiados fue 64 (46-77) años. La mediana del PSA pre-radioterapia fue 2,3 (0,04-26,1)ng/ ml. El tiempo medio entre la cirugía y la radioterapia fue 17,4 (3-72) meses. La dosis media administrada fue 68 (58-70) Gy. El seguimiento medio fue 50,5 (15-117) meses. Resultados: de 25 pacientes prostatectomizados que recibieron radioterapia 4 (16%) desarrollaron estenosis de la anastomosis vesicouretral. El tiempo medio desde la finalización de la radioterapia hasta la aparición de la estenosis fue de 4 meses (1-22). Por otro lado, 36 (15,4%) pacientes prostatectomizados que no recibieron radioterapia postoperatoria presentaron esta misma complicación. Comparativamente no se apreciaron diferencias significativas entre ambos grupos (p = 0,599).Conclusiones: en nuestra revisión retrospectiva, la radioterapia postoperatoria no incrementó de forma significativa la incidencia de estenosis de la anastomosis vesicouretral (AU)
Objective: To know the incidence of vesicourethral anastomotic stricture in patients with prostate cancer treated with radical prostatectomy. Our secondary aim was to verify if postoperative radiotherapy increases the risk of presenting anastomotic stricture. Materials and methods: We retrospectively checked the clinical records of patients that had undergone radical prostatectomy as their primary treatment between January 2000 and December2008, with a minimum clinical follow-up of 12 months. Of the total patients, 258 met the foregoing requirements. Of them, 25 (9.6%) received postoperative radiotherapy, 12 (48%) received adjuvant radiotherapy and 13 (52%) received salvage radiotherapy. The mean age of the patients that received radiotherapy was 64 (46-77) years. The mean pre-radiotherapy PSA was 2.3 (0.04-26.1) ng/ ml. The mean time between surgery and radiotherapy was 17.4 (3-72) months. The mean dosage administered was 68 (58-70) Gy. The mean follow-up was 50.5(15-177) months. Results: Of 25 prostatectomized patients that received radiotherapy, four (16%) developed vesicourethral anastomotic stricture. The mean time from the completion of the radiotherapy until the appearance of the stricture was 4 months (1-22). On the other hand, 36 (15.4%) of the prostatectomized patients that did not receive postoperative radiotherapy presented the same complication. Comparatively, we did not note significant differences between both groups (p = 0.599). Conclusions: In our retrospective review, postoperative radiotherapy did not significantly increase the incidence of vesicourethral anastomotic stricture (AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Estrechez Uretral/tratamiento farmacológico , Estrechez Uretral/historia , Estrechez Uretral/radioterapia , Estrechez Uretral/cirugía , Cuidados Posoperatorios/psicología , Cuidados Posoperatorios/normas , Cuidados Posoperatorios/tendencias , Cuidados Posoperatorios/estadística & datos numéricos , Estrechez Uretral/clasificación , Estrechez Uretral/complicaciones , Estrechez Uretral/diagnóstico , Estrechez Uretral/prevención & control , Cuidados Posoperatorios/ética , Cuidados Posoperatorios/métodos , Cuidados PosoperatoriosRESUMEN
OBJECTIVE: To know the incidence of vesicourethral anastomotic stricture in patients with prostate cancer treated with radical prostatectomy. Our secondary aim was to verify if postoperative radiotherapy increases the risk of presenting anastomotic stricture. MATERIALS AND METHODS: We retrospectively checked the clinical records of patients that had undergone radical prostatectomy as their primary treatment between January 2000 and December 2008, with a minimum clinical follow-up of 12 months. Of the total patients, 258 met the foregoing requirements. Of them, 25 (9.6%) received postoperative radiotherapy, 12 (48%) received adjuvant radiotherapy and 13 (52%) received salvage radiotherapy. The mean age of the patients that received radiotherapy was 64 (46-77) years. The mean pre-radiotherapy PSA was 2.3 (0.04-26.1) ng/ ml. The mean time between surgery and radiotherapy was 17.4 (3-72) months. The mean dosage administered was 68 (58-70) Gy. The mean follow-up was 50.5 (15-177) months. RESULTS: Of 25 prostatectomized patients that received radiotherapy, four (16%) developed vesicourethral anastomotic stricture. The mean time from the completion of the radiotherapy until the appearance of the stricture was 4 months (1-22). On the other hand, 36 (15.4%) of the prostatectomized patients that did not receive postoperative radiotherapy presented the same complication. Comparatively, we did not note significant differences between both groups (p=0.599). CONCLUSIONS: In our retrospective review, postoperative radiotherapy did not significantly increase the incidence of vesicourethral anastomotic stricture.
Asunto(s)
Complicaciones Posoperatorias/etiología , Prostatectomía/métodos , Traumatismos por Radiación/etiología , Radioterapia Adyuvante/efectos adversos , Estrechez Uretral/etiología , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Anciano , Anastomosis Quirúrgica , Terapia Combinada , Humanos , Incidencia , Laparoscopía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Prostatectomía/efectos adversos , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Traumatismos por Radiación/epidemiología , Dosificación Radioterapéutica , Estudios Retrospectivos , Terapia Recuperativa , Estrechez Uretral/epidemiología , Obstrucción del Cuello de la Vejiga Urinaria/epidemiologíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Divertículo/diagnóstico , Divertículo/cirugía , Retención Urinaria/complicaciones , Retención Urinaria/diagnóstico , Diagnóstico Diferencial , Imagen por Resonancia Magnética/métodos , Urografía/métodos , Divertículo/patología , Divertículo , Vejiga Urinaria/patología , Vejiga Urinaria/cirugía , Vejiga Urinaria , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga UrinariaRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Diafragma Pélvico/anomalías , Diafragma Pélvico/patología , Diafragma Pélvico/cirugía , Obstrucción Ureteral/complicaciones , Obstrucción Uretral/complicaciones , Incontinencia Fecal/complicaciones , Incontinencia Fecal/diagnóstico , Incontinencia Urinaria/complicaciones , Incontinencia Urinaria/diagnóstico , Laparotomía/métodos , Micción/fisiología , Metrorragia/complicaciones , Metrorragia/diagnóstico , Prolapso Uterino/complicaciones , Prolapso Uterino/diagnóstico , Prolapso Uterino/cirugíaRESUMEN
INTRODUCTION: We have implanted the FlowSecure artificial sphincter for the first time in October 2006. The prototype was originally conceived and designed by Professor Craggs M. D. and Professor Mundy A.R. Preliminary clinical results were reported in nine patients early this year. Our objective is to spread technique for surgical implantation. METHODS: Combined perineal and abdominal incisions are required for exposure of bulbar urethra, creation of a cavity in the para-vesical space and dissection of a pocket under de scrotal wall. A trocar with a stylet is routed from the abdominal incision to the perineal incision to pass the deflated cuff to the perineal site. The cuff is placed around the urethra and secured with Prolene sutures. After refilling the cuff, fluid is removed from the system until the stress relief balloon becomes just indented (atmospheric pressure 0). The pump is placed in the scrotum and the balloons in the paravesical space. RESULTS: We have implanted our first FlowSecure artificial sphincter in a patient with severe stress incontinence following a T.U.R.P. The surgical technique is simple and associated with little handling. He was discharged from hospital 4 days after the procedure and it was decided that pressurisation was unnecessary. DISCUSSION: Surgical implantation of the new FlowSecure artificial urinary sphincter is an easy procedure in males with stress urinary incontinence. Knigth et al. reported 30 to 40 minutes operating time, 4 days mean hospital stay and unnecessary pressurisation procedure in 3 out of their 9 patients. It seems that their results are reproducible.
Asunto(s)
Incontinencia Urinaria de Esfuerzo/cirugía , Esfínter Urinario Artificial , Humanos , MasculinoRESUMEN
Introducción: En Octubre de 2006 se implantó por primera vez en nuestra Institución el nuevo esfínter urinario artificial FlowSecure TM. El prototipo fue concebido y diseñado por los Profesores Craggs MD y Mundy AR y los resultados clínicos preliminares de 9 pacientes fueron publicados a mediados del 2006. Nuestro objetivo es el de difundir la descripción detallada de la técnica quirúrgica para la implantación de esta nueva prótesis. Materiales y métodos: Se requiere una incisión perineal para la exposición de la uretra bulbar y una abdominal para la creación de un espacio paravesical y de un bolsillo escrotal. Se coloca un trocar con un estilete desde la incisión abdominal a la perineal para pasar el manguito desinflado, que se ajusta a la uretra y se asegura con tres puntos de Prolene. Tras volver a llenar el manguito se extrae líquido hasta que se forma una muesca en el reservorio de asistencia al estrés, indicando que el sistema está a presión atmosférica 0. Se coloca entonces la bomba en el escroto y los reservorios en el espacio paravesical. Resultados: El esfínter fue colocado en un paciente con incontinencia de esfuerzo tras una RTU de próstata. La técnica es simple, el paciente se fue de alta al cuarto día y no fue necesario presurizar el sistema porque el paciente recuperó la continencia desde la retirada de la sonda. Discusión: La implantación en uretra bulbar es muy sencilla. Los resultados en este paciente concuerdan con los de Knigth et al., que describen tiempo quirúrgico de 30 a 40 minutos, media de estancia hospitalaria de 4 días y presurización innecesaria en tres de sus nueve pacientes. Parece que la técnica y los resultados son reproducibles
Introduction: We have implanted the FlowSecure artificial sphincter for the first time in October 2006. The prototype was originally conceived and designed by Professor Craggs M. D. and Professor Mundy A.R. Preliminary clinical results were reported in nine patients early this year. Our objective is to spread technique for surgical implantation. Methods: Combined perineal and abdominal incisions are required for exposure of bulbar urethra, creation of a cavity in the para-vesical space and dissection of a pocket under de scrotal wall. A trocar with a stylet is routed from the abdominal incision to the perineal incision to pass the deflated cuff to the perineal site. The cuff is placed around the urethra and secured with Prolene sutures. After refilling the cuff, fluid is removed from the system until the stress relief balloon becomes just indented (atmospheric pressure 0). The pump is placed in the scrotum and the balloons in the paravesical space. Results: We have implanted our first FlowSecure artificial sphincter in a patient with severe stress incontinence following a T.U.R.P. The surgical technique is simple and associated with little handling. He was discharged from hospital 4 days after the procedure and it was decided that pressurisation was unnecessary. Discussion: Surgical implantation of the new FlowSecure artificial urinary sphincter is an easy procedure in males with stress urinary incontinence. Knigth et al. reported 30 to 40 minutes operating time, 4 days mean hospital stay and unnecessary pressurisation procedure in 3 out of their 9 patients. It seems that their results are reproducible
Asunto(s)
Masculino , Persona de Mediana Edad , Humanos , Esfínter Urinario Artificial , Prótesis e Implantes/tendencias , Prótesis e Implantes , Incontinencia Urinaria de Esfuerzo/diagnóstico , Incontinencia Urinaria de Esfuerzo/cirugía , Esfínter Urinario Artificial/tendencias , Esfínter Urinario Artificial/efectos adversos , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/tendenciasRESUMEN
No disponible
Asunto(s)
Masculino , Anciano , Humanos , Riñón/anomalías , Trastornos Urinarios/etiología , Retención Urinaria/etiologíaRESUMEN
The presence of intellectual impairment in MS has been known since the first studies of Charcot and Vulpain who described the memory's weakening appearing in these patients. However, the interest for the MS' cognitive deficits has specially increased in the decade of the 80's. In this article, a bibliographical revision of the last published studies about the cognitive impairment in MS has been made paying attention to those superior functions known as more affected. The aim of this article is to known the correlation among the cognitive impairment and the MR images, level of disability, fatigue, duration and course of the disease and demographic factors.
Asunto(s)
Trastornos del Conocimiento/etiología , Esclerosis Múltiple/psicología , Encéfalo/patología , Trastornos del Conocimiento/epidemiología , Fatiga/etiología , Humanos , Esclerosis Múltiple/patología , Vaina de Mielina/patología , Pruebas Neuropsicológicas , Prevalencia , Índice de Severidad de la EnfermedadRESUMEN
Although the presence of intellectual impairment in multiple sclerosis (MS) is known since the first studies of the disease frequently the impairment goes equally undetected for the patients, their family and the physician because the physical dysfunction is much more outstanding. In this study a population of 50 persons suffering clinically definite MS (Poser's criteria) and 50 healthy controls matched with the patients in sex, age and cultural level were submitted to a neuropsychological test battery (NPTB). The existence of a correlation between the punctuation obtained in the NPTB and factors such as the level of disability, the time of evolution, the type of MS and the work status was searched. The results show a greater difficulty in doing tasks requiring attention-concentration skills thus giving the MS patients significantly lower scores in the memory test when compared with the controls. The execution of all tests was worse in those forms of MS with the longest time of evolution, higher EDSS scores and the chronic-progressive types. In our study the loss of the working status was never due to the intellectual impairment, it was because of the physical disability.
Asunto(s)
Trastornos del Conocimiento/etiología , Esclerosis Múltiple/psicología , Adolescente , Adulto , Anciano , Trastornos del Conocimiento/diagnóstico , Fatiga/etiología , Femenino , Humanos , Masculino , Trastornos de la Memoria/diagnóstico , Trastornos de la Memoria/etiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Evaluación de Capacidad de TrabajoRESUMEN
UNLABELLED: The clinical potential of free radical (OFR) ablative therapy is dependent upon the proportion of the total injury caused by the reperfusion mechanism compared with the proportion resulting from ischemic injury itself. Prostaglandin cascade can both activate and be activated by OFR. AIM: to investigate the influence of different periods of cold ischemis in renal tissue (cortex and medulla) -regarding superoxide dismutase (S.O.D.) activity, the amount of erythrocyte trapping and prostaglandin synthesis. Also, to evaluate the effect of exogenous S.O.D. in the prevention of reperfusion injury. MATERIAL AND METHODS: 48 Lewis male rats (200-250 g) received renal isografts (RTx) preserved in Collins solution at 4 C for different periods: control group (8) non operated; group I (8) immediate RTx; group II (8) 12 hrs; group III (8) 18 hrs; group IV (8) 12 hrs+S.O.D. (13 mg/kg e.v.); group V (8) 18 hrs+S.O.D. (13 mg/kg e.v.). Before reperfusion all recipients received 1 ml of 51-Cr labelled erythrocytes. After 15 min. reperfusion grafts were removed and samples (cortex and medulla) obtained for measuring trapping of erythrocytes. S.O.D. activity and prostaglandins (PGe2, TxB2, 6-Keto-PGF1). RESULTS: A strong correlation was found between the duration of cold ischemia and the amount of trapping both in cortex and in medulla. S.O.D. administration induced a significant drop of trapping. In non-operated rats S.O.D. activity in cortex was two fold medulla content. However, after reperfusion, a significant decrease in cortex was found in all groups. S.O.D. administration raised S.O.D. activity in cortex similar to control values.(ABSTRACT TRUNCATED AT 250 WORDS)