RESUMEN
PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6%) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.
Asunto(s)
Competencia Clínica , Calidad de la Atención de Salud , Resección Transuretral de la Próstata/normas , Urología/normas , Anciano , Antiinfecciosos Locales , Etanol , Humanos , Hiponatremia/etiología , Indicadores y Reactivos/farmacocinética , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Próstata/patología , Próstata/cirugía , Sorbitol/farmacocinética , Estadísticas no Paramétricas , Síndrome , Factores de Tiempo , Resección Transuretral de la Próstata/efectos adversosRESUMEN
PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6 percent) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.
Asunto(s)
Anciano , Humanos , Masculino , Persona de Mediana Edad , Competencia Clínica , Calidad de la Atención de Salud , Resección Transuretral de la Próstata/normas , Urología/normas , Antiinfecciosos Locales , Etanol , Hiponatremia/etiología , Indicadores y Reactivos/farmacocinética , Tamaño de los Órganos , Estudios Prospectivos , Próstata/patología , Próstata/cirugía , Estadísticas no Paramétricas , Síndrome , Sorbitol/farmacocinética , Factores de Tiempo , Resección Transuretral de la Próstata/efectos adversosRESUMEN
Synaptic vesicle proteins are suggested to travel from the trans-Golgi network to active zones via tubulovesicular organelles, but the participation of different populations of endosomes in trafficking remains a matter of debate. Therefore, we generated a green fluorescent protein (GFP)-tagged version of the vesicular acetylcholine transporter (VAChT) and studied the localization of VAChT in organelles in the cell body and varicosities of living cholinergic cells. GFP-VAChT is distributed to both early and recycling endosomes in the cell body and is also observed to accumulate in endocytic organelles within varicosities of SN56 cells. GFP-VAChT positive organelles in varicosities are localized close to plasma membrane and are labeled with FM4-64 and GFP-Rab5, markers of endocytic vesicles and early endosomes, respectively. A GFP-VAChT mutant lacking a dileucine endocytosis motif (leucine residues 485 and 486 changed to alanine residues) accumulated at the plasma membrane in SN56 cells. This endocytosis-defective GFP-VAChT mutant is localized primarily at the somal plasma membrane and exhibits reduced neuritic targeting. Furthermore, the VAChT mutant did not accumulate in varicosities, as did VAChT. Our data suggest that clathrin-mediated internalization of VAChT to endosomes at the cell body might be involved in proper sorting and trafficking of VAChT to varicosities. We conclude that genesis of competent cholinergic secretory vesicles depends on multiple interactions of VAChT with endocytic proteins.
Asunto(s)
Acetilcolina/metabolismo , Proteínas Portadoras/genética , Proteínas Portadoras/farmacocinética , Proteínas de Transporte de Membrana , Neuronas/metabolismo , Proteínas de Transporte Vesicular , Secuencia de Aminoácidos , Animales , Vesículas Cubiertas por Clatrina/metabolismo , Endocitosis/fisiología , Expresión Génica/fisiología , Proteínas Fluorescentes Verdes , Indicadores y Reactivos/farmacocinética , Proteínas Luminiscentes/genética , Proteínas Luminiscentes/farmacocinética , Datos de Secuencia Molecular , Mutagénesis/fisiología , Neuronas/citología , Transmisión Sináptica/fisiología , Transfección , Células Tumorales Cultivadas , Proteínas de Transporte Vesicular de AcetilcolinaRESUMEN
Spinal cord transection (SCT) delays gastric emptying (GE), and intestinal and gastrointestinal (GI) transit of liquid in awake rats. This study evaluates the neural mechanisms involved in this phenomenon. Male Wistar rats (N = 147) were fasted for 16 h and had the left jugular vein cannulated followed by laminectomy or laminectomy + complete SCT between T4 and T5 vertebrae. The next day, a test meal (1.5 ml of a phenol red solution, 0.5 mg/ml in 5% glucose) was administered by gavage feeding and 10 min later cervical dislocation was performed. Dye recovery in the stomach, and proximal, mid and distal small intestine was determined by spectrophotometry. SCT inhibited GE and GI transit since it increased gastric recovery by 71.3% and decreased mid small intestine recovery by 100% (P < 0.05). Subdiaphragmatic vagotomy, celiac ganglionectomy + section of the splanchnic nerves, i.v. hexamethonium (20 mg/kg) or yohimbine (3 mg/kg) prevented the development of the SCT effect on GE and GI transit. Pretreatment with i.v. naloxone (2 mg/kg), L-NAME (3 mg/kg) or propranolol (2 mg/kg) was ineffective. Bilateral adrenalectomy or guanethidine (10 mg/kg) increased the magnitude of the GE inhibition, while i.v. prazosin (1 mg/kg) or atropine (0.5 mg/kg) decreased the magnitude but did not abolish the GE inhibition. In summary, the inhibition of GI motility observed 1 day after thoracic SCT in awake rats seems to involve vagal and possibly splanchnic pathways.
Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Fenómenos Fisiológicos del Sistema Digestivo , Sistema Digestivo/inervación , Vaciamiento Gástrico/fisiología , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/fisiopatología , Motilidad Gastrointestinal/fisiología , Traumatismos de la Médula Espinal/complicaciones , Médula Espinal/fisiopatología , Animales , Sistema Nervioso Autónomo/efectos de los fármacos , Sistema Nervioso Autónomo/patología , Fenómenos Fisiológicos Cardiovasculares/efectos de los fármacos , Sistema Digestivo/efectos de los fármacos , Ganglios Simpáticos/fisiología , Ganglios Simpáticos/cirugía , Ganglionectomía/efectos adversos , Vaciamiento Gástrico/efectos de los fármacos , Enfermedades Gastrointestinales/tratamiento farmacológico , Motilidad Gastrointestinal/efectos de los fármacos , Indicadores y Reactivos/farmacocinética , Masculino , Fenolsulfonftaleína/farmacocinética , Ratas , Ratas Wistar , Médula Espinal/patología , Nervios Esplácnicos/fisiología , Nervios Esplácnicos/cirugía , Simpatectomía/efectos adversos , Vértebras Torácicas , Factores de Tiempo , Vagotomía/efectos adversosRESUMEN
Macromolecular translocation (MMT) across the nuclear envelope (NE) occurs exclusively through the nuclear pore complex (NPC). Therefore, the diameter of the NPC aqueous/electrolytic channel (NPCC) is important for cellular structure and function. The NPCC diameter was previously determined to be approximately equal to 10 nm with electron microscopy (EM) using the translocation of colloidal gold particles. Here we present patch-clamp and fluorescence microscopy data from adult cardiomyocyte nuclei that demonstrate the use of patch-clamp for assessing NPCC diameter. Fluorescence microscopy with B-phycoerythrin (BPE, 240 kDa) conjugated to a nuclear localization signal (NLS) demonstrated that these nuclei were competent for NPC-mediated MMT (NPC-MMT). Furthermore, when exposed to an appropriate cell lysate, the nuclei expressed enhanced green fluorescence protein (EGFP) after 5-10 h of incubation with the plasmid for this protein (pEGFP, 3.1 MDa). Nucleus-attached patch-clamp showed that colloidal gold particles were not useful probes; they modified NPCC gating. As a result of this finding, we searched for an inert class of particles that could be used without irreversibly affecting NPCC gating and found that fluorescently labeled Starburst dendrimers, a distinct class of polymers, were useful. Our patch-clamp and fluorescence microscopy data with calibrated dendrimers indicate that the cardiomyocyte NPCC diameter varies between 8 and 9 nm. These studies open a new direction in the investigation of live, continuous NPC dynamics under physiological conditions.