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OBJECTIVE: To evaluate the diagnostic performance of the length of the tumor contact with the capsule (LTC) and the apparent diffusion coefficient (ADC) map in the prediction of microscopic extracapsular extension in patients with prostate cancer who are candidates for radical prostatectomy. MATERIAL AND METHODS: We used receiver operating curves to retrospectively study the diagnostic performance of the ADC map and the LTC as predictors of microscopic extracapsular extension in 92 patients with prostate cancer and moderate to high risk who were examined between May 2011 and December 2013. RESULTS: The optimal cutoff for the ADC map was 0.87× 10-3 mm2/s, which yielded an area under the ROC curve of 72% (95% CI: 57%-86%), corresponding to a sensitivity of 83% and a specificity of 61%. The optimal cutoff for the LTC was 17.5mm, which yielded an area under the ROC curve of 74% (95% CI: 61%-87%), corresponding to a sensitivity of 91% and a specificity of 57%. Combining the two criteria improved the diagnostic performance, yielding an area under the ROC curve of 77% (95% CI: 62%-92%), corresponding to a sensitivity of 77% and a specificity of 61%. We elaborated a logistic regression model, obtaining an area under the ROC curve of 82% (95% CI: 73%-93%). CONCLUSIONS: Using quantitative measures improves the diagnostic accuracy of multiparametric magnetic resonance imaging in the staging of prostate cancer. The values of the ADC and LTC were predictors of microscopic extracapsular extension, and the best results were obtained when both values were used in combination.

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Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.

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BACKGROUND: Irritable Bowel Syndrome (IBS) is a disorder characterized by abdominal pain or discomfort associated with changes in bowel habit. Currently there are no objective outcome measures for evaluating the effectiveness of treatments for this disorder. AIMS: To determine the usefulness of a method of analysis that employs polar vectors to evaluate the effectiveness of IBS treatments. METHODS: Data from a Phase IV clinical study with 1677 active IBS-Rome III patients who received 100mg of pinaverium bromide+300mg of simethicone (PB+S) po bid for a period of four weeks were used for the analysis. Using the Bristol Stool Scale as a reference, the consistency and frequency of each type of bowel movement were recorded weekly in a Bristol Matrix (BM) and the data were expressed as polar vectors. RESULTS: The analysis showed a differential response to the PB+S treatment among the IBS subtypes: in reference to the IBS with constipation subtype, the magnitude of the vector increased from 10.2 to 12.5, reaching maximum improvement at two weeks of treatment (p<0.05, Scheffé). In the IBS with diarrhea and mixed IBS subtypes, the magnitude of the vector decreased from 19 to 14 (p<0.05) and from 16.5 to 13 (p<0.05), respectively, with continuous improvement for a period of four weeks. There was no definable vectorial pattern in the unsubtyped IBS group. CONCLUSIONS: Analysis with polar vectors enables treatment response to be measured in different IBS subtypes. All the groups showed improvement with PB+S, but each one had its own characteristic response in relation to vector magnitude and direction. The proposed method can be implemented in clinical studies to evaluate the efficacy of IBS treatments.

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A vectorial theory that brings new insight into the nature of diffraction is used to obtain mathematical expressions that evaluate diffraction patterns in the near field. The equations allow us to discriminate between the contributions of the vectorial and the scalar approaches. In the near field we studied the pattern of light diffracted through a circular aperture, and it was proved that the vectorial approach is significant in a region very near the circular aperture. In spite of the obvious differences between the circular aperture and other obstacles, the present theory may also be used with other geometries.

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Using a vectorial formulation, we show that Huygens's secondary-sources density is constant in plane waves, and it depends only on the wavelength. We also illustrate that Huygens's secondary sources, which act as emitters of secondary wavelets, have a finite dimension equal to 3 pi/2k(2).

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La episiotomía es un procedimiento de uso frecuente, casi rutinario en la práctica obstétrica diaria. Sin embargo, sus indicaciones no fueron sometidas a una evaluación crítica durante casi 60 años, hasta los años 80. Los beneficios propuestos para la realización de este procedimiento: la prevención de desgarros perineales severos, la protección de la integridad del piso pélvico, la disminución de lesiones sobre el feto no se han demostrado claramente y por el contrario, parece que la realización de este procedimiento puede favorecer resultados contrarios a los perseguidos e involucrar un mayor riesgo de complicaciones y molestias para las pacientes. Se debe abandonar la práctica rutinaria de la episiotomía y evaluar adecuadamente que pacientes se beneficiarían del procedimiento

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The antiviral activity of butanol- and acetic acid-soluble fractions, prepared from the leaves and stems of Phyllanthus orbicularis H.B.K., has been investigated against acyclovir-sensitive or -resistant herpes simplex virus type 1 (HSV-1) strains, using human foreskin fibroblast (HFF) and green ape kidney (Vero) cell lines. Both fractions showed antiviral selectivity indexes (SI) from 10.3 to 22.8, while their extracellular virucidal activities reached SI values ranging from 371 to 1,040. Time-addition experiments suggested that the active compounds present in the studied fractions acted on early steps of the virus replication cycle.

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BACKGROUND AND OBJECTIVE: The usefulness of preoperative angiographic evaluation of the internal mammary artery (IMA) is controversial. The aim of this study is to evaluate the problem by a basic cost-benefit analysis. METHODS: One hundred and twenty-one patients whose coronary findings (left main disease and/or severe stenosis of the left anterior descending artery) made use of the IMA as a bypass graft a consideration were studied. The IMA was cannulated by the same right Judkins catheter used in the coronarography; the specific catheter was only used if the cannulation was not successful with the right Judkins. We measured the time it took for a good angiography of the IMA to be obtained; the anatomy and the size for each IMA were studied and compared with the size of the left anterior descending artery. RESULTS: An optimal angiographic picture of the IMA was obtained in 119 cases (98.3%); a specific catheter was used only in 3 patients. The mean of the time employed was 170 seconds (8-900 s) and no complications were related to IMA cannulations. Angiography findings relevant to any planned surgery were demonstrated in 15 patients (12%): large proximal branches (10); occlusion stenosis or a caliber insufficient for IMA (3); and occlusion or proximal subclavian stenosis (2). CONCLUSIONS: We have observed that the relation between the cost and the obtained information is adequate to warrant its performance, because angiographic findings relevant to planned surgery can be very important, even though they are fairly infrequent. Moreover, these findings can be achieved rapidly without additional cost.

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To evaluate the usefulness of treadmill exercise test in the diagnosis of coronary restenosis, we have chosen a sequential and probabilistic analysis. The rate of coronary restenosis found in the sample (n = 213) was of 30%. This initial probability of having restenosis was radically changed by the recurrence of typical angina: 77% in patients with this symptom, 17% in those without (p < 0.001). In contrast, the qualitative result of the exercise test was unable to change significantly the probabilities established after anamnesis. This was due to a lower specificity for exercise test (76%) than for angina (93%), the sensibility being the same (56%) for both. Employment of a discriminant value that integrates different ergometric variables did not enhanced sensibility, but allowed the identification of a good number of false positive results and therefore palliated the negative impact of faulty specificity. Being applied to a "discordant group" (no angina/positive exercise test, n = 34) was able to achieve a significant change in probability: from 15% to 50% or 4% (p < 0.01), according to the discriminant being lesser or greater than a preestablished value. In conclusion, prevalence of the event and evaluation of symptomatology are both important to estimate the probability of suffering coronary restenosis. On the contrary, exercise test, in the absence of a weighty method, adds more confusion than clarity to the analysis of the problem. Our results can be used to improve the follow-up of patients who have been successfully dilated by angioplasty.

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En los dos últimos decenios han sido motivo de numerosas revisiones los tumores de células transicionales en personas menores de 20 años de edad. Se presenta un estudio retrospectivo de seis pacientes con tumores vesicales de urotelio que, en el momento de iniciarse la sintomatología, tuvieran edad de 20 años o menor. En todos los casos el primer signo fue la hematuria, y el diagnóstico se confirmó entre dos y 60 meses después. El tratamiento de elección fue la electrorresección transuretral y, en un caso, consistió en cistectomía parcial con reimplantación de los uréteres. Se trata de carcinomas de buen pronóstico, por su baja tendencia invasora que se pone de manifiesto en la revisión bibliográfica y se confirma en esta serie. Es un padecimiento poco frecuente (0.4 por ciento) en este grupo etario; sin embargo, se debe tener en cuenta en el diagnóstico diferencial de la hematuria en el paciente joven. Se proponen la ecografía y la citología urinarias como métodos para el seguimiento de estos tumores.

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