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The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term.155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous).Mean follow-up 26,2±13,4 months. 47.1% developed early CR, with mean time until onset of 12,2±8,7 months. Univariate analysis the mean PSA was correlated with CR (290±905,1 ng/mL in non CR, 519,1±1437,2 ng/mL in CR, P.001), mean age (73,3±8,3 years in non CR, 69,1±9,3 in CR P=.01), mean PSA nadir (15,5±57,3ng/mL in non CR, 15,9±23,7 ng/mL in CR, p0,001), Gleason (in ≥8, HR:2,11. 95% CI: 1.22-3.65, p=0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P.001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P=.01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P.001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P=.02).PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term.

Intracardiac thrombosis is a rare complication in patients receiving haemodynamic support with venous-arterial extracorporeal membrane oxygenation (VA-ECMO), but it has a high risk of mortality. This case report describes a patient who suffered cardiogenic shock after a ST-segment elevation myocardial infarction (STEMI) and who presented with intracardiac thrombosis during VA-ECMO support on two occasions after mitral valve replacement. The first one was after the insertion of a mechanical prosthesis, and the second, after replacing it with a biological valve.

To evaluate the effect of glaucoma on visual function, as well as quality of life in children and quality of life perceived by caregivers in children up to 16 years of age.An observational and prospective study was designed using the questionnaire GQL-15 (Glaucoma Quality of Life) and conducted on children and caregivers. The questionnaire VFQ-25 (Visual Functioning Questionnaire) was conducted on children. Different variables of the clinical history that could influence the quality of life and visual function were recorded.The study included 24 patients with a mean age of 9.13±3.08 years, and included 3 with unilateral involvement, and 20 diagnosed with primary congenital glaucoma. Parents reported a worse quality of life than children. The result of the GQL-15 survey was 32.3±11.56 points in children and 37.52±14.59 points in caregivers (P=.001). The parameter most related to quality of life and visual function was the mean deviation (MD) of the visual field in the best eye. A statistically significant correlation was found between the result of GQL-15 and the mean deviation of the visual field (children: R=0.63, P.01, caregivers: R=0.81, P.001).Functional loss has an impact on the quality of life and visual function in children with glaucoma, although the quality of life perceived by the caregivers is worse than that perceived by the child.

We report a case of a 35-years-old man who presented a massive haemothorax and hypovolemic shock following cardiac surgery, from spontaneous rupture of a phrenic artery. A quick diagnosis and immediate intervention is crucial to manage the patient.

BACKGROUND/OBJECTIVES: It is well known that increased abdominal fat is associated with cardiovascular (CV) risk. Perirenal fat has been recently associated with CV risk in adults. However, studies with children are lacking. We investigated the relationship of perirenal fat and other abdominal fat depots (including preperitoneal, intra-abdominal and subcutaneous fat) with carotid intima-media thickness (cIMT-a surrogate marker of CV risk) in prepubertal children, so as to identify novel markers that can be easily assessed and used in the early prevention of cardiovascular disease. SUBJECTS/METHODS: Subjects were 702 asymptomatic prepubertal Caucasian children (418 lean, 142 overweight and 142 obese) who were recruited in a primary care setting. Ultrasound measurements (perirenal, preperitoneal, intra-abdominal and subcutaneous fat and cIMT), clinical (body mass index (BMI) and systolic blood pressure) and metabolic parameters (insulin resistance (HOMA-IR), high molecular weight (HMW) adiponectin and serum lipids) were assessed. RESULTS: Perirenal fat was associated with diverse metabolic and CV risk factors in all the studied subjects. However, in overweight and obese children, perirenal fat was mostly associated with cIMT (P

Background: Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases, biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk, disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA). Methods: This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients were treated with ZA (4mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I (P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (beta-CTX) were analysed at all points in the study. Data on disease progression, SREs development and survival were recorded. Results: Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were predictive of survival time, with beta-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship between bone markers and disease progression. Conclusion: In patients with PCa and bone metastases treated with ZA, beta-CTX and P1NP can be considered suitable predictors for mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of treatment are especially important., This study was supported by Novartis Oncology Spain. As this was a multicenter study, Adknoma Health Research (Barcelona, Spain) collected and ordered data throughout the study. We especially thank Margarida Garcia from Adknoma who followed carefully the development of the study. M. Martin-Fernandez was a fellow of the Conchita Rabago Foundation.

Introduction: The aim of this study was to show the satisfaction and treatment adherence in erectile dysfunction (ED) in the medium and long term. Material and methods: A descriptive, comparative study was conducted in 2 centres through telephone interviews with patients who came for an initial visit between 2012 and 2014 for ED. A complete case history review was conducted on the use of and withdrawal from treatment. For current use, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Global Assessment Questionnaire (GAQ) were filled out; for past use, only the GAQ was filled out. For the statistical analysis, we employed Fisher's exact test for comparisons of percentages and the Kruskal-Wallis test to compare means. Results: The study included 250 patients; 20.8% were prescribed intraurethral alprostadil (ALP-IU), 17.2% were prescribed intracavernous alprostadil (ALP-IC), 92.8% were prescribed a first IPD5, and 24.8% were prescribed at least a second IPD5. The treatment withdrawal rate was 62.07% for the first IPD5, 41.94% for the last IPD5, 69.23% for the ALP-IU and 65.11% for the ALP-IC (P=.007). The main reason for withdrawal for the IPD5 was a lack of response (32.76% of those who took IPD5). In addition to withdrawal, there were adverse reactions for ALP-IU and ALP-IC (28.85% and 11.63%, respectively). The mean duration of use until withdrawal was 4.3 months for IPD5, 2.2 months for ALP-IU and 5.5 months for ALP-IC (P=.064). The most favourable GAQ and EDITS scores were observed for IPD5 (EDITS score of 74). Sildenafil and tadatafil had the longest usage times (mean > 5 months). Conclusions: The withdrawal rate for treating ED is high, with short usage times of a few months. A lack of response and adverse reactions were the main causes for withdrawal. The drugs that provide greater satisfaction are the IPD5, although there are no significant differences in the mean usage time between the different types and in aspects such as the mean usage time to withdrawal or the withdrawal rates. (C) 2016 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Objective: Congenital high airway obstruction syndrome (CHAOS) normally has a dire prognosis due to laryngeal atresia and association with other anomalies. However, rare cases with an isolated tracheal membrane have been described. We assessed systematically the larynx and vocal cords in fetuses with CHAOS, with the goal of identifying such cases and attempting fetoscopic deobstruction. Methods: Between 2008 and 2012, 7 cases of CHAOS were referred to our institution. The ultrasonographic aspect of the larynx and trachea was assessed. We report the ultrasound findings, necropsy findings of 6 cases and perinatal outcome in 1 case undergoing therapy. Results: In 6 cases, laryngeal atresia was presumed by ultrasound and confirmed by necropsy after termination of pregnancy. In 1 case, normal appearance of the vocal cords led to suspicion of a possible isolated tracheal web completely occluding the trachea. Fetoscopy confirmed the finding, thus the membrane was perforated. Lung size normalized and hydrops resolved. A normal fetus was delivered at term, requiring no respiratory support. At 9 months of age, the infant showed a normal laryngoscopy and was developing well. Conclusions: Systematic ultrasound assessment of the vocal cords can be performed in fetuses with CHAOS. We report the first case of long-term intact survival after fetoscopic airway deobstruction.

Microperc is the upgraded form of percutaneous nephrolithotomy miniaturization. The aim of this study is to compare prospectively microperc and retrograde intrarenal surgery for the treatment of renal stones smaller than 2 cm.A comparative prospective study of both techniques was carried out between January 2014 and June 2015. Thirty-five patients were divided in two groups: Group A, 17 patients treated by retrograde intrarenal surgery and Group B, 18 patients treated by microperc. Stone clearance was assessed using CT scan 3 months after surgery.Both groups were statistically comparable as demographic variables and stone size was similar (16.76 mm Group A vs 15.72 mm Group B). Success rate, hospital stay and JJ stenting were similar for both groups. There was no statistically significant difference regarding post-operatory complications: 17.64% Group A vs 5.56% Group B (p=0,062), all of them Clavien I and II. Surgical time was statistically different (63.82 min Group A vs 103.24 min Group B) as well as hemoglobin drop (0.62 g/dl Group A and 1.89 g/dl Group B).Microperc is an effective and safe procedure for the treatment of renal lithiasis smaller than 2 cm, which makes it a good alternative to retrograde intrarenal surgery for this stone size. However, more prospective studies that include a larger cohort are necessary to confirm our results.

Erectile dysfunction and low sexual desire are multifactorial diseases. The decrease in testosterone levels is one of the causes, but the effect of estradiol is not well known. Moreover, study has shown that the testosterone/estradiol ratio has more influence over sexuality than does estradiol alone. The aim of the study was to determine whether the balance between testosterone and estradiol has any relation to some aspects of sexual function. It was an ambispective study of 230 patients with urological problems unrelated to sexuality. They underwent a detailed history and hormone study including total, free, bioavailable testosterone and estradiol. They completed the Sexual Health Inventory for Men and questions 11 and 12 of the IIEF15 were used to assess impairment in sexual desire. The T/E ratio was calculated, and the relationship between the different parameters and erectile function and sexual desire were studied by univariate and multivariate analysis. The mean age was 66.32 ± 8.17 years. The percentage of patients with erectile dysfunction was 60.9% (7% severe, 14.3% moderate, 12.6% mild to moderate and 27% mild) and decreased sexual desire was 46.5%. Age, free and biodisponible testosteron were the only variables with a positive linear association with erectile dysfunction and decreased sexual desire. Age was the only independent variable for both, erectile dysfunction and sexual desire, in the multiple linear regression. There was no association between a testosterone/estradiol imbalance and an alteration in erectile function and sexual desire. Consequently, in the clinical study of these patients, it is not necessary to request estradiol in the laboratory analyses.

The aim of this study is to determine which cancer and demographic criteria influence the indication for surgery (radical prostatectomy) or radiation therapy (external or brachytherapy) in the treatment of prostate cancer.An analysis of the 2714 patients of the 2010 National Prostate Cancer Registry treated with curative intent. The analysed variables were age, prostate-specific antigen (PSA), prostate volume, the number of biopsy cores, the percentage of positive cores, the stage, Gleason score, the type of pathologist, the presence of perineural invasion and the study centre. We analysed the association among these variables and the type of treatment (surgery vs. radiation therapy/brachytherapy), using a univariate analysis (Student's t test and chi-squared) and a binary multiple logistic regression.The 48.12% of the patients (1306/2714) were treated with surgery, and 51.88% (1,408/2,714) underwent radiation therapy/brachytherapy. Differences were observed between the patients treated with prostatectomy and those treated with radiation therapy/brachytherapy (p.05) in age (63.50±6.5 vs. 69.0±6.7), PSA (8.76±16.97 vs. 13.21±15.88), biopsied cores, percentage of positives cores (30.0±22 vs. 38.7±29), Gleason score (G6: 53.9% vs. 46.1%; G7: 45% vs. 55% G8-10: 26.6%, 73.4%), stage (localised: 50% vs. 50%; locally advanced: 14.6% vs. 85.4%), perineural invasion and hospital centre. In the multivariate analysis, the selected independent variables were age, PSA, percentage of positives cores, stage, Gleason score and hospital centre.According to our study, age, tumour aggressiveness and stage and the centre where the patient will be treated affect the selection of curative treatment for prostate cancer.

To determine the influence of barbed suture in laparoscopic radical prostatectomy.A retrospective study of 150 patients who underwent laparoscopic radical prostatectomy was carried out by our department. The patients were divided in two groups according to the kind of suture used during the vesicourethral anastomosis: conventional 3-0 absorbable multifilament running suture (group 1) and bidirectional barbed suture (Quill®) (group 2). Operating time, postoperatory urinary fistula, hospital stay and catheter duration were analyzed in both groups.After the analysis of all the preoperative variables, such as age, PSA, prostate volume, Gleason and stage on biopsy, no statistically significant differences were found in both groups. Operating time was significantly shorter in Group 2 (169±43 min vs 215±45 min, p=0.00). Statistically significant differences were found regarding postoperative urinary fistula rate, hospital stay and urethral catheterization duration, favourable to Group 2.The use of bidirectional barbed suture (Quill®) for vesicourethral anastomosis in laparoscopic radical prostatectomy, when compared with the conventional suture, shortens surgical time, reduces urinary fistula rate, catheter duration and hospital stay, as the anastomosis is easily performed and prevents leakage.

Monochorionic (MC) twins represent a significant proportion of perinatal morbidity and mortality. Overall, 1 of 3 MC twin pregnancies will develop complications in relation to the MC placenta and the presence of interfetal placental anastomoses. From a clinical standpoint, these complications can be grouped into four main types of clinical problems: chronic transfusion, acute transfusion, growth discordance, and discordant malformation. Differential diagnosis of MC twin complications is still challenging due to frequent overlap of their clinical signs and the complex relationships between them. Clinical experience demonstrates that most instances of wrong management derive from failure to comply with a basic set of rules for diagnosis and management. In this review, we propose a simplified approach to the understanding of MC twin pregnancy, its potential complications, and the key concepts allowing adequate differential diagnosis and targeted management.

Aim: To conduct a meta-analysis of randomised clinical trials (RCTs) in order to evaluate the development of conjunctival hyperaemia after the use of latanoprost versus travoprost and bimatoprost, in patients with ocular hypertension or glaucoma. Methods: In order to identify the potentially relevant RCTs, a systematic literature retrieval was conducted in Medline, Embase and Cochrane Controlled Trials Register (1995–April 2007) databases The outcome measure was the appearance of conjunctival hyperaemia during the study. Statistical analyses included the calculation of odds ratio (OR) and its respective confidence interval, along with intertrial statistical heterogeneity. Publication bias was evaluated through a funnel plot, and a sensitivity analysis was also performed. Results: In total, 13 RCTs involving 2222 patients with ocular hypertension or glaucoma were included, five comparing latanoprost versus travoprost, seven comparing latanoprost versus bimatoprost and one comparing latanoprost versus travoprost and bimatoprost. The combined results showed that latanoprost produced lower occurrence of conjunctival hyperaemia than both travoprost (OR = 0.51; 95% CI 0.39 to 0.67, p

Prostate cores from transrectal biopsies are usually sent in separate vials for pathological processing. Although this is a common practice, there are controversial studies on its usefulness. We wanted to compare the rate of prostate cancer diagnosis between processing samples in 2 containers and processing them in individual containers to see if there are differences. Our secondary objective was to check the rate of diagnosis of various tumour subtypes in each of the 2 groups.A retrospective observational study was conducted of 2,601 cases of prostate biopsies. Ten cores were extracted in each biopsy. We divided the sample into 2 groups: biopsies sent in 2 containers to the department of pathology (left and right lobes) or sent in 10 (one for each cylinder), according to the different criteria used in our centre in the past. We then classified the cases according to the absence of neoplasia, insignificant tumour (involvement of just 1 cylinder,5%, Gleason score7), Gleason 6 or Gleason≥7. A bivariate statistical analysis was performed using the chi-squared test.A total of 1,777 participants were included in the 2-container group, and 824 were included in the 10-container group. We diagnosed a rate of 32.4% of cancers in the 2-container group and 40% in the 10-container group, a difference that was statistically significant (P.001). The insignificant carcinomas were diagnosed more often in the 2-container group than in the 10-container group (6.4% vs. 4.3%, respectively; P=.03). Samples with a Gleason score of 6 were diagnosed more often in the 10-container group than in the 2-container group (11.9% vs. 8.1%, respectively; P=.002). The same occurred with the Gleason score≥7 (23.8% in the 10-container group vs. 17.9% in the 2-container group; P.001).We diagnosed more prostate cancers when sending biopsied cores in individual containers. Once the procedure was conducted, we also observed in our series a reduction in the diagnoses of insignificant carcinoma to the detriment of an increased diagnosis of not insignificant carcinomas.

In the literature it is shown that the use of PSA is occasionally wrong, by requesting this marker in very young or very old men, and repeated measurements in short periods of time. The main objective of this study was to describe the use of PSA in daily practice by primary care physicians in our area, dealing with aspects such as the importance of patient age, the value in the screening for prostate cancer, or the subjective beliefs about its usefulness. A secondary objective was the comparison of use, and beliefs among doctors who claim to know PSA well, and those who do not.A descriptive and comparative study was conducted using questionnaires that were handed to primary care doctors in all health centres in our area. A descriptive analysis was performed and response rates among doctors who thought they had enough information about PSA, and those who did not, were compared using the Chi-squared test.A total of 103 questionnaires were received from the physicians, with 83.5% claiming to have sufficient knowledge about the PSA. The professionals in this latter group request PSA at an earlier age (P=.029), with a higher frequency (P=.011) and have more doubts about its usefulness (P=.009) than those with less knowledge. Almost half (49.5%) said they request less than 50 determinations per year, and 33% between 50 and 100. More than half (53.4%) of doctors would not request the first PSA on a patient until their 50s, and up to 49% request it up to 80 years. The true value of PSA has been established many times by 64.1% of requesters, and 29.1% believe it is unhelpful in the diagnosis of cancer.In our study, 64% of primary care physicians have considered the true value of the PSA several times, and 29% believe it to be of little use in the diagnosis of prostate cancer. In addition, some data suggest it has limited use due to the fact that 50% made less than 50 PSA requests per years, and 28% of the professionals would never request it on a male without urinary symptoms. In this study, it has been observed that those professionals who claim not to have enough information about the PSA make more requests in patients of an older age, and consider that it is of limited use as a marker.

To study the structures of the iridocorneal angle using anterior segment optical coherence tomography (OCT) defining their tomographic characteristics and quantifying their identification frequency.A cross-sectional study was performed on 267 right eyes of 267 consecutive healthy patients. Fourier domain OCT RTVue (Optovue Inc, CA, EE. UU.) was used to examine the iridocorneal angle in the nasal and temporal sectors. The structures evaluated were: Sclerocorneal limbus, sclerocorneal transition, Schwalbe's line, trabecular meshwork, Schlemm's canal, scleral spur, and angular recess. Within and between agreements to identify structures were calculated using Cohen's kappa coefficient.The mean age was 41.3 ± 14.3 years (range 20-80), with 57% being women. The sclerocorneal limbus, sclerocorneal transition, and Schwalbe's line were identified by 98.7, 97 and 93.4% of the images, respectively, with the trabecular meshwork and Schlemm's canal being identified in 91% of cases. The scleral spur could be identified in 85.4%, and the angular recess in 74.5%. There was no difference in the identification between the temporal and nasal sectors. Within and between agreement was k=0.92 and k=0.88, respectively, in the identification of the structures of the total images studied.Fourier domain OCT is a reliable technique for the identification of the structures of the iridocorneal angle, among which can be highlighted are, the trabecular meshwork, Schlemm's canal, scleral spur, and Schwalbe's line.

Chronic migraine (CM), with or without medication overuse, is a common condition in the general population. It has traditionally been assumed that suffering CM has an impact on a patient's socio-occupational and educational level. Our goal was to analyse these characteristics in a cohort of patients with CM and compare them to the general population.We used a telephone interview and an ad hoc questionnaire to record and analyse the sociodemographic characteristics of 150 patients with a diagnosis of CM according to the criteria of the International Headache Classification. Results were compared to those obtained by the Third Health Survey of Asturias, conducted in 2012.Of the 150 patients, 142 were women (95%). Married patients accounted for 59.3% of the total interviewees, while 22% were single, 12.6% divorced, and 6% were widowed. Regarding educational level, we found that 73% of our patients had completed secondary or higher education and 25% had completed only primary education. Sixty per cent of these patients are occupationally active, while the rest are not actively employed. Overall, these figures do not differ from those published by the Third Health Survey of Asturias.The classic idea that CM has a negative impact on patients' educational, personal, and occupational situations was not confirmed in our series. In fact, most patients with CM reported a medium-high educational level and a good socio-occupational status. However, since our series includes only CM patients attended in a specialist clinic, our results are not necessarily applicable to all patients with CM.

To describe the personal and family antecedents and clinical characteristics of patients with eating disorders (EDs) in a population of the south of Spain; to analyse the influence of lifestyles, family functioning, socioeconomic status (SES), and psychological characteristics in these processes. A university-based case–control study. University Hospital (Andalusia, Spain). A total of 120 patients with EDs and 240 controls. SCOFF, EDI, APGAR family, and SES questionnaires. In all, 67.5% of patients presented anorexia (AN), 15% bulimia (BN), and 17.5% mixed forms. EDs emerged at around 18–20 y (95% CI 17.9–19.8). Factors associated with EDs are psychiatric conditions (depression OR: 4.16, anxiety OR: 4.59), more frequent use of medication (OR: 2.26), dietary fibre (OR: 2.59), and laxatives (OR: 3.47). Toxics consumption, sport activity, SES, and family antecedents of pathology are not associated with EDs. An inverse relationship was found between family functioning and the scores in various subscales of the EDI. Eating disorders in Andalusia (Spain) are influenced significantly more by psychological, family, and cultural factors than by social factors.

Objective: To analyse the differences in family functioning and socioeconomic status between subjects with disorders of eating behaviour and the healthy population, considering the possible relationship of these factors with the psychic characteristics of patients, with consumption of various substances, and with sexual practices. Design: Case–control study. Setting: ‘Puerta del Mar’ University Hospital (Andalusia, Spain). Subjects: Conducted on a sample of 120 patients with AN and BN, and 240 controls with an identical distribution by age and sex. Interventions: SCOFF, eating disorder inventory (EDI), Apgar family and socioeconomic questionnaires are utilised. Results: Patients with disorders of eating behaviour present greater family dysfunctioning than controls; among cases, this difference is greater in the acute forms, but there are no differences between recent situations or crises due to previous episodes. Family dysfunction is associated with higher scores of multiple subscales of the EDI, which is corroborated on analysing each of the Apgar parameters independently. Family functioning is not associated with other variables such as breast-feeding or consumption of toxic substances. Socioeconomic status does not differentiate cases from controls, or acute situations from evolving ones, or new episodes from other crisis episodes, although differences may be found in the psychic manifestations according to social class. Conclusions: It is confirmed that family functioning has an influence in these types of disorder, in their evolution and in the psychic characteristics of the patients, without any evidence being found of a relationship between these disorders and socioeconomic status.

The involvement of seminal vesicles in prostate cancer can affect the prognosis and determine the treatment. The objective of this study was to determine whether we could predict its infiltration at the time of the prostate biopsy to know when to indicate the biopsy of the seminal vesicles.observational retrospective study of 466 patients who underwent seminal vesicle biopsy. The indication for this biopsy was a prostate-specific antigen (PSA) level greater than 10 ng/ml or an asymmetric or obliterated prostatoseminal angle. The following variables were included in the analysis: PSA level, PSA density, prostate volume, number of cores biopsied, suspicious rectal examination, and preservation of the prostatoseminal angle, studying its relationship with the involvement of the seminal vesicles.Forty-one patients (8.8%) had infiltrated seminal vesicles and 425 (91.2%) had no involvement. In the univariate analysis, the cases with infiltration had a higher mean PSA level (P.01) and PSA density (P.01), as well as a lower mean prostate volume (P.01). A suspicious rectal examination (20.7% of the infiltrated vesicles) and the obliteration or asymmetry of the prostatoseminal angle (33.3% of the infiltrated vesicles) were significantly related to the involvement (P.01). In the multivariate analysis, we concluded that the probability of having infiltrated seminal vesicles is 5.19 times higher if the prostatoseminal angle is not preserved (P.01), 4.65 times higher for PSA levels19.60 ng/dL (P.01) and 2.95 times higher if there is a suspicious rectal examination (P = .014). Furthermore, this probability increases by 1.04 times for each unit of prostate volume lower (P.01). The ROC curves showed maximum sensitivity and specificity at 19.6 ng/mL for PSA and 0.39 for PSA density.In this series, greater involvement of seminal vesicles was associated with a PSA level ≥20 ng/ml, a suspicious rectal examination and a lack of prostatoseminal angle preservation.

The use of bariatric surgery to treat diabetes mellitus (DM) requires procedures developed for morbid obese in patients with normal and over-weight. Therefore, we started tailoring one anastomosis gastric bypass (BAGUA) adapted to each patient. This study analyzes changes in body composition (BC) of patients with BMI 23–50 after BAGUA as well as influence of DM and MS. We studied 79 (37 diabetic and 42 non-diabetic) patients (BMI 23–50) who completed all evaluation appointment (preoperative, 10 days, 1, 3, 6, and 12 months) after tailored BAGUA for obesity, diabetes, or diabesity. Patients were classified according to BMI (23–29, 30–34, 35–50) and bearing or not diabetes. Variables are components of BC as well as DM and MS. Preoperatively, mean values of weight varied 37 kg (78–115 kg), muscle mass (MM) 8 kg (54–62 kg), while fat mass (FM) 30 kg (22–53 kg). Basal metabolism (BM) was higher in diabetic. After surgery, percentage (%) of excess weight loss (%EWL) ranged from 76 % (BMI 35–50) to 128 % (BMI 23–29), FM 56 % (BMI 23–29) to 65 % (BMI 35–50), without differences bearing DM. MM 12 % (non-diabetics BMI 30–34) to 17 % (diabetics BMI 35–50) and visceral fat (VF) 50 % (diabetics BMI 30–34) to 56 % (non-diabetics BMI 35–50). After tailored BAGUA, MM maintains steady while FM is highly reduced and variable. BM is reduced in all groups. Diabetics lose less weight and VF but more MM than non-diabetic patients. Preoperative presence of MS influences the changes in BC.

Top athletes are subjected to intense training to achieve high performance. There are factors such as diet and strenuous exercise that affects body composition and can modify the performance. The aim of the study was to evaluate the effect of a personalized plan of diet and training on body composition.We studied the body composition of 18 professional rugby players using Kinanthropometry parameters. The study was conducted from the preseason to the end of the season taking into account the position of the player for measuring exercise intensity, and developing a personalized nutritional and training plan to each player.At baseline the players were away from the internationally recommended body composition, with high percentages of body fat. Appropriate and personalized diet plans and training custom achieved fat percentages close to those recommended.The personalized program of diet and training directed has adequate leverage to improve all parameters studied them bringing them as close to the ideal.Introducción: Los atletas de alto rendimiento están sometidos a grandes esfuerzos para lograr un alto nivel. Hay factores como la alimentación y el ejercicio extenuante que afectan la composición corporal modificando el rendimiento. Sin embargo con un plan personalizado de dieta y entrenamiento se puede modificar la composición corporal y lograr un máximo rendimiento. Métodos: Estudiamos la composición corporal de 18 jugadores profesionales de rugby por medio de bioimpedancia y kineantropometría. El estudio se llevó a cabo desde la pretemporada hasta el final de la temporada tomándose en cuenta la posición de juego para medir la intensidad del ejercicio, y desarrollando un plan personalizado de alimentación y entrenamiento a cada jugador. Resultados: Los jugadores estaban lejos de la composición corporal recomendada internacionalmente, con altos porcentajes de grasa corporal. Con planes personalizados de dieta y entrenamiento se logró porcentajes de grasa cercanos a los recomendados. Conclusiones: El programa personalizado de dieta y el entrenamiento dirigido, tiene una adecuada influencia para mejorar todos los parámetros de composición corporal estudiados acercándolos al ideal.

The objectives of this prospective study are to present our experience with retrograde intrarenal surgery (RIRS), and to analyze its results and complications.150 patients with renal stones were treated with RIRS. 111 cases showed single stones whilst multiple stones were observed in 39 cases. The mean size was 19.12mm (r: 5-74). Success rate was defined as the absence of residual stones or the presence of fragments ≤2mm.in 21 (14%) patients RIRS could not be performed on first attempt because it was impossible to place the ureteral access sheath. The immediate success rate was 85.7%, and 91.6% at three months later. The average operating time was 85min (r: 25-220). Postoperative complications were observed in 22 cases (14.6%), although most of them were classified as Clavien 1 and 2 (19 cases), and only 2% (3 cases) showed Clavien 4 complications (sepsis requiring admission in the intensive care unit). 10 patients underwent a second procedure in order to complete the treatment. Thus, the number of procedures per patient was 1.06. There were no late complications.the treatment of renal stones with flexible ureteroscopy using the ureteral access sheath shows a high successful rate with a low complication rate. In order to define its indication more precisely, randomized studies comparing RIRS with minimally invasive percutaneous nephrolithotomy procedures (miniperc and microperc) would be necessary.

Non-organic visual loss is the presence of ocular symptoms without an organic base that justifies it, and can occur in up to 5% of the children attending Ophthalmology Outpatients. A suspicion and the management of this situation are essential for a proper diagnosis, not only to avoid unnecessary referrals to other specialties, but also to avoid health spending, in addition to reducing parental distress by the possible presence of eye disease in their children.

Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy.We recruited consecutive patients that underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables.From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumour, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was .85 (.78-.92), and dropped to 0.79 when excluding the BTA-test (P=.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumours.In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumours, resulting in a more efficient use of resources in the healthcare system.

Although bariatric surgery proved to be a very effective method in the treatment of patients in whose pancreas still produce insulin (type 2 diabetes), the accompanied metabolic syndrome and their diabetes complications, there is no information on the effect of this type of surgery in BMI24-34 patients when pancreas do not produce insulin at all (type 1, LADA and long term evolution type 2 diabetes among others).We report preliminary data of a serie of 11 patients all with a C-peptide values below 0.0 ng/ml. They were followed for 6 to 60 months (mean 19 months) after surgery. We studied the changes in glycemic control, evolution of the metabolic syndrome and diabetes complications after one anastomosis gastric bypass (BAGUA).All values relative to glycemic control were improved HbA1c (from 8.9 ± 0.6 to 6.7 ± 0.2%), FPG (Fasting Plasma Glucose) [from 222.36 ± 16.87 to 94 ± 5 (mg/dl)] as well as the daily insulin requirement of rapid (from 40.6 ± 12.8 to 0 (U/d) and long-lasting insulin (from 41.27 ± 7.3 U/day to 15.2 ± 3.3 U/day). It resolved 100% of the metabolic syndrome diseases as well as severe hypoglycaemia episodes present before surgery and improved some serious complications from diabetes like retinopathy, nephropathy, neuropathy, peripheral vasculopathy and cardiopathy.Tailored one anastomosis gastric bypass in BMI 24-34 C peptide zero diabetic patients eliminated the use of rapid insulin, reduced to only one injection per day long-lasting insulin and improved the glycemic control. After surgery disappear metabolic syndrome and severe hypoglycaemia episodes and improves significantly retinopathy, neuropathy, nephropathy, peripheral vasculopathy and cardiopathy.Introducción: Aunque la cirugía bariátrica ha demostrado ser un método muy eficaz en el tratamiento de pacientes diabéticos cuyo páncreas aún es capaz de producir insulina (diabetes tipo 2), así como del síndrome metabólico y las complicaciones relacionadas con la diabetes, no hay información sobre el efecto de este tipo de cirugía en pacientes IMC 24-34 cuando el páncreas no produce insulina en absoluto (tipo 1, tipo LADA y diabetes tipo 2 de larga evolución, entre otros). Métodos: Presentamos datos preliminares de una serie de 11 pacientes todos con valores de Péptido C0,0 ng/ml. El seguimiento postoperatorio varia de 6 y 60 meses (media 19 meses). Estudiamos los cambios en el control de la glucemia, evolución del síndrome metabólico y complicaciones relacionadas con la diabetes tras bypass de una anastomosis (BAGUA). Resultados: Mejoraron todos los valores relativos al control glucémico HbA1c (de 8,9 ± 0,6 a 6,7 ± 0,2%), FPG (Glucosa Plasmática Ayunas) (de 222,36 ± 16,87 a 94 ± 5 (mg/dl)) así como el requerimiento diario de insulina, tanto de insulina rápida (de 40,6 ± 12,8 a 0 U/día) como de insulina retardada (41,27 ± 7,3 U/día a 15,2 ± 3,3 U/día). Se resolvieron el 100% de las comorbilidades estudiadas y se mejoraron algunas complicaciones graves derivadas de la diabetes como retinopatía o nefropatía. Conclusiones: El bypass gástrico de una anastomosis adaptado a pacientes diabéticos IMC24-34 con péptido C cero elimina el uso de insulina de acción rápida, reduce a una sola inyección diaria la insulina retardada y mejora el control glucémico. Tras la cirugía desaparecen el síndrome metabólico y los episodios severos de hipoglucemia, y mejora significativamente la retinopatía, neuropatía, nefropatía, vasculopatía periférica y cardiopatía.

An alcoholic patient with loss of vision in his right eye and a peripapillar haemorrhage, who then presented with a venous thrombosis. Blood analysis revealed hyperhomocysteinemia with coagulation parameters within the normal range. In the follow-up he developed a bilateral optic neuropathy.An increase in homocysteine levels is common in alcoholics, and it has been considered a vascular risk factor. Folic acid and vitamins B6 and B12 deficiency may lead to hyperhomocysteinemia, as they participate in its metabolism.When presented with a retinal occlusive disease or ischemic optic neuropathy in young patients, coagulation disorders and elevated levels of homocysteine should be ruled out.

In colorectal cancer there is discussion about the possible relation between the mismatch repair protein expression (MMRPE) and tumour lymphocytic infiltration (TLI), as well as the possible prognostic effect of both factors.A review was made of 243 colorectal cancers, consecutively resected. We made an immunohystochemical study of the MMRPE of MLH1, MSH2 and MSH6. The TLI was evaluated through CD3 staining in the tumoural epithelium. We compared mortality and post-operative tumoural progression amongst the cases with and without MMRPE and with and without TLI. Additionally, we studied mortality and tumoural progression amongst MMRPE (+) cases, according to whether or not they presented TLI.Thirteen point six percent of the tumours expressed MMRPE (+) and 25.5% TLI (+). The follow-up was: 73.8±34.6 months. The frequency of TLI (+) turned out to be similar between MMRPE (+) tumours: 27.3% and MMRPE (-): 25.2% (p = 0.80). The MMRPE (+) cases showed less mortality: 12.1% versus 23.3% (p = 0.15) and less tumoural progression: 21.2% versus 29% (p = 0.35). The ITL neoplasias (+) had a lower mortality: 9.7% versus 26% [p = 0.007; OR = 3.27(1.25-9.05)] and tumoural progression: 12.9% versus 33.1% [p = 0.002; OR = 3.35 (1.42-8.15)]. The 9 MMRPE (+) and ILT (+) tumours did not present mortality or tumoural progression, against a mortality: 16.7% and progression: 29.2% of the 24 MMRPE (+) and TLI (-) cases p = 0.19 and p = 0.07 respectively.No relation was found between MMRPE and TLI, with very similar rates of TLI (+) between cases with and without MMRPE. The LTI (+) showed a favourable prognostic effect higher than that of the MMRPE (+). The combination of LTI (+) and MMRPE (+) seems to have an accumulative protective effect, although its limited frequency reduces the significance of the finding.

78-year-old male patient diagnosed with Charles Bonnet syndrome (CBS) showing secondary visual deficit toward end-stage glaucoma. He progressed to amaurosis, with an abrupt disappearance of hallucinations in parallel to the loss of residual vision.The paradoxical cessation of CBS occurs when the patient loses residual vision and progresses to amaurosis. The lack of stimulation, both in the corresponding retina and the cortex, lead to the disappearance of hallucinations because the desafferented and hyper-excited neurons lose the necessary stimulus that triggers CBS.

Patients with a previous history of heparin-induced thrombocytopenia are at a higher risk for thromboembolic events, and heparin administration is formally contraindicated. Bivalirudin has been reported as an alternative therapy whenever an intervention that requires systemic anticoagulation and cardiopulmonary by-pass pump is needed. We present the case of a patient diagnosed with heparin-induced thrombocytopenia and heparin-PF4 (+) antibodies requiring a triple cardiac valve replacement who developed fulminant coagulopathy after bivalirudin administration. A discussion on the serious difficulties that the management of these types of patients involves, as well as a review of prevention strategies are presented.

To evaluate, in a cohort of 248 fetuses seen at a tertiary referral center, the frequency of isolated ventricular septal defects (VSD) among all congenital heart defects (CHD), the association with chromosomal and postnatal anomalies and the rate of spontaneous closure.This was a 6-year study on 10,800 women referred for fetal echocardiography, with 995 confirmed cases of CHD. The prevalence and characteristics of VSDs were analyzed, including follow-up until 1 year of age. Multivariate binary logistic regression analysis was performed to test the independent contribution of the ratio of the diameter of the VSD to that of the aorta (VSD/aorta ratio) (0.5 or ≥ 0.5) and location of VSD (perimembranous or muscular) in the prediction of spontaneous closure before the age of 1 year.Two hundred and forty-eight VSDs (24.9% of all CHDs) were diagnosed, of which 216 (87.1%) were muscular and 32 (12.9%) perimembranous. Median gestational age at diagnosis was 30.4 (range, 17-41) weeks and mean size 2.6 ± 0.77 mm. Clinically relevant chromosomal anomalies were found in one (3.1%) perimembranous VSD compared with none in 216 muscular defects (P = 0.12). Postnatal malformations were diagnosed in eight of the 211 cases (3.8%) evaluated at 12 months postpartum. Spontaneous closure occurred prenatally in 13 fetuses (5.2%) and postnatally in 151 of the 198 infants (76.3%) who had an open VSD at birth. Closure was predicted by the VSD/aorta ratio (odds ratio (OR) 0.445 (95% CI, 0.216-0.914); P0.03) and location (OR 0.385 (95% CI, 0.160-0.926); P0.03).In our fetal cardiology unit, isolated muscular VSD is today the most prevalent CHD. In contrast to the findings of postnatal studies, muscular VSDs were more common than perimembranous VSDs. Perimembranous VSDs were associated with a higher risk of chromosomal anomalies than were muscular VSDs, which had a similar risk to those of normal pregnancies. Spontaneous closure of the VSD was frequent and occurred in most cases postnatally.

Isoprostanes (IsoPs) are a series of prostaglandin (PG)-like compounds formed non-enzymatically through free-radical-induced peroxidation of arachidonic acid. They are considered as 'gold-standard' biomarkers for oxidative stress, in general, and lipid peroxidation, in particular.A new qualitative and quantitative analytical method for the determination of 13 eicosanoids in human urine using solid-phase extraction (SPE) and ultra-pressure liquid chromatography coupled to tandem mass spectrometry (UPLC/MS/MS) has been developed. The SPE was optimized by comparison of the extraction efficiency and recoveries of three distinct cartridges: Strata X-AW, C18 Sep-Pak, and Oasis HLB. The UPLC/MS/MS approach in the multiple reaction monitoring (MRM) mode was developed using negative electrospray ionization (ESI).The validated method provides a high-throughput assay with an adequate linearity from 0.16 to 330 ng mL(-1). The limit of detection (LOD) and limit of quantification (LOQ) for each analyte showed low intervals (0.021-0.64 ng mL(-1) and 0.042-1.28 ng mL(-1), respectively). Urinary IsoPs were determined in 24 healthy volunteers and ranged from 685 to 3480 ng 24 h(-1) and from 864 to 7511 ng 24 h(-1) in urine from women and men, respectively.This analytical method could constitute a useful tool for the determination of oxidative stress biomarkers in clinical studies in which IsoPs may evidence early pathological conditions, as suggested by the determination of the baseline IsoPs content in human urine, since it improves upon the detection capacity of previously described methods. The quantity of IsoPs excreted in urine was higher than that found in previous reports due to the total hydrolysis of the conjugated forms.

Erectile dysfunction (ED) is a multifactorial process which requires an integral approach. It is also a sentinel symptom of endothelial dysfunction that opens a door to the overall health of a man.To analyze the prevalence of cardiovascular risk factors and other disorders in patients with ED. The relationship between the severity of ED and the total serum testosterone level and the therapeutic approach of doctors were also analyzed.An observational, multicenter, national study in patients18 years who came to uroandrology or primary care consultations. Sociodemographic, anthropometric, lifestyle habits and medical history data of patients and the physician's therapeutic approach, were all collected. ED was diagnosed and total testosterone was assessed when necessary.1340 patients aged from 22-81 years took part in the study. Age was the most prevalent factor to develop the condition. Abdominal obesity, diabetes, and smoking had a high prevalence. Half of the patients presented psychological and/or sexual problems. 33% and 13.5% of patients had suboptimal levels of total testosterone (cut-off point of 12 nmol/l and 8 nmol/l, respectively), with a direct relationship with disease severity.Our study supports the need to examine cardiovascular risk factors in patients with ED and to identify patients who might benefit from testosterone replacement therapy. Psychological disorders should receive specialized care.

We have studied the motor response induced by independent administration of 4 different doses of a dopamine D 2 [(+)-PHNO] and a dopamine D 1 (CY 208–243) receptor agonist in 5 MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) monkeys. Both drugs had similar antiparkinsonian effects and both elicited choreic dyskinesias. Simultaneous administration of (+)-PHNO [(+)-4-propyl-9-hydroxynaphthoxazine] and CY 208–243 [(−)4,6,6a,7,8,12b-hexahydro-7-methylindolo[4,3a-b] phenanthyxidine] did not result in modification of the dose-response curve induced by each dopamine receptor agonist given alone. Pretreatment with the dopamine D 1 receptor antagonist SCH 23390 (0.8 mg/kg) and the dopamine D 2 receptor antagonist sulpiride (60 mg/kg) reduced the magnitude and the duration of the motor response induced by (+)-PHNO and CY 208–243, respectively, but did not modify the intensity and characteristics of choreic dyskinesias. These results demonstrate that the motor effects and the dyskinesias cannot be dissociated by selective dopamine D 1 and D 2 receptor stimulation. It appears that stimulation of dopamine D 1 and D 2 receptors by endogenous dopamine is required to obtain the full motor response induced by selective dopamine receptor agonists as demonstrated by the reduction of the motor improvement found after pretreatment with SCH 23390 and sulpiride.

Diabetes mellitus type 2 (DMT2) is a major cause of death in the world. The medical therapy for this disease has had enormous progress, but it still leaves many patients exposed to the complications developed from the disease. It is well known the beneficial effects of bariatric surgery in obese diabetic patients, however it is important to investigate if the same principles of bariatric surgery that improve diabetes in obese patients, could be applied to non obese normal weight diabetics.Thirteen diabetic patients operated by One Anastomosis Gastric Bypass (BAGUA), were evaluated in the preoperative period and 1,3 and 6 months after surgery. Body weight and composition, Fasting Plasma Glucose, HbA1c levels, blood pressure and serum lipids levels were analyzed, as well as the monitoring of the immediate postoperative treatment necessities for Diabetes and other metabolic syndrome comorbidities.After the surgery the 77% of the patients resolves its T2DM, 46% from surgery, and rest noted an significant improvement of the disease in spite of having a C peptide level near to zero some of the patients. The comorbidities, mainly hypertension and lipid abnormalities experience improvement early. All patients reduce their weight and the amount of fat mass until values consistent with their age and height.The One Anastomosis Gastric Bypass leads to resolution or improvement of T2DM in non obese normal weight patients. The best results are obtained in patients with few years of diabetes, without or short term use of insulin treatment and high C-peptide levels.

The aim of this study was to identify the rate of clinical significant disease (Gleason score6 or tumor volume0.5 cc in the RP specimen) among patients who had an insignificant prostate cancer on biopsy, evaluating the presence of prognostic factors.Patients who fulfilled the following criteria were included: PSA ≤ 10ng/ml, T1c disease, biopsy Gleason Score ≤ 6 affecting5% of only 1 core and who had undergone a radical prostatectomy. The following variables were studied: Age, PSA, dPSA, free/total PSA ratio and prostatic volume assessed by transrectal ultrasound.In a series of 2424 biopsies, 77 patients completely fulfilled the inclusion criteria, with 66.23% (n=51) of clinical significant disease in the prostatectomy specimen. No differences were observed between these patients and those with insignificant disease in age, PSA, free/total PSA ratio. However, prostatic volume was significantly greater and PSA density significantly lower in those patients with an insignificant disease. Statistical analysis using a logistical regression showed that dPSA was the only prognostic factor (OR: 25067.10, CI 95%: 26.79-2.34×10(7), P=.004).These findings suggest that a high rate of patients who have a suspected insignificant prostate cancer on biopsy have a clinical significant disease, being dPSA the only independent prognostic factor.

Gatrointestinal stromal tumours (GIST) harbour oncogenic mutations in tyrosin kynases receptors (RTKs) including KIT and PDGFRA. The inhibition of this activity has been regarded as the primary target for the treatment of these patients. Diagnosis of GIST relies on c-KIT inmunoreactivity; however there is a 4-15% of GISTs that are C-KIT negative which may lead to underdiagnosis of GISTs and possible withholding of therapy. The novel gene DOG1 has been found overexpressed in GISTs and has potential as a diagnostic marker for GISTs showing even more sensitivity (Se) and specificity (Sp) than c-KIT for the diagnosis of these tumors. In this study we compared the (Se) and (Sp) of DOG1 in typical and atypical GISTs (c-KIT positive or negative) with c-KIT and other mesenchymal neoplasms in the differential diagnosis of GISTs We examined 40 GIST (39 showed inmunoreactivity for c-KIT and one was c-KIT negative) and another seven fusiform tumors. An inmunohistochemical panel was performed with c-KIT, CD34, smooth muscle actin, DOG1 and S100 antibodies on both types of neoplasms. The overall Se and Sp of DOG1 and KIT in GISTs were nearly identical: 100 and 97,5%. Negativity for DOG1 was observed in all fusiform mesenchymal neoplasms. DOG1 is highly expressed in GIST and its expression seems quite specific for these tumours when the differential diagnosis includes another mesenchymal neoplasms. DOG1 should be added to the diagnostic panel evaluating GISTs.

To determine possible differences in the intraocular pressure (IOP) and ocular pulse amplitude (OPA) lowering capacity of the fixed drug combinations dorzolamide/timolol and brinzolamide/timolol.In this cross-sectional study, one of the eyes of 25 healthy subjects was randomly assigned to treatment with dorzolamide/timolol and the other eye with brinzolamide/timolol. After instilling the drops, possible adverse effects (e.g., blurred vision, itching) were assessed in each eye. This assessment was repeated 30 minutes later. IOP and OPA were determined In each eye by dynamic contour tonometry at baseline and two hours following treatment.Both fixed drug combinations significantly reduced IOP and OPA with no differences detected between treatment groups. Among the adverse effects recorded, itching was significantly greater in the first assessment in the eyes treated with dorzolamide/timolol (P = .011). This difference was no longer apparent in the second assessment.Both fixed combinations were similarly effective in reducing intraocular pressure and ocular pulse amplitude. Adverse effects related to both treatments were mild and well-tolerated, though itching occurred most frequently in the eyes treated with dorzolamide/timolol.

We compared cefonicid (2 g every 12 h) and ceftriaxone (2 g every 24 h) for their efficacy and safety in treating spontaneous bacterial peritonitis in cirrhotic patients in an open randomized clinical trial (30 patients in each group). Clinical, laboratory, and bacteriologic characteristics were similar in both groups. Ceftriaxone-susceptible strains were isolated on 44 occasions (94%), and cefonicid-susceptible strains were isolated on 43 occasions (91.5%). The antibiotic concentration in ascitic fluid/MIC ratio for ceftriaxone was > 100 throughout the dose interval (24 h), while it was lower for cefonicid (between 1 and 18). A total of 100% of patients treated with ceftriaxone, and 94% of those treated with cefonicid were cured of their infections (P was not significant). Hospitalization mortality was 37% in the cefonicid group and 30% in the ceftriaxone group (P was not significant). The time that elapsed between the initiation of treatment and the patient's death was shorter in the cefonicid group patients (5.3 +/- 3.90 days) than in the ceftriaxone group patients (11.8 +/- 9.15 days) (P < 0.05). None of the patients presented with superinfections, and only two patients treated with cefonicid and three patients treated with ceftriaxone developed colonizations with Enterococcus faecalis or Candida albicans. Ceftriaxone and cefonicid are safe and useful agents for treating cirrhotic spontaneous bacterial peritonitis, although the pharmacokinetic characteristics of ceftriaxone seem to be more advantageous than those of cefonicid.

Washing the renal cavities using minipercutaneous surgery shaft is an ideal technical procedure for retrograde intrarenal surgery (RIRS) when lithiasic fragmentation is significant or if the anatomy of the renal cavities may obstruct the spontaneous elimination of fragments.we performed 37 RIRS on 35 patients with renal lithiasis (14 men, 21 women) with a mean age of 56 (range 33-72) years, divided into two groups in accordance with the size of their kidney stones. Group A, 23 patients with lithiasis1.5 cm; Group B, 12 cases with lithiasis1.5 cm. 28 patients had a single kidney stone and 7 had multiple stones.Flexible uretrorenoscopy, 7.5 Fr (Flex-X(®, Karl Storz) by means of a ureteral access sheath. Holmium laser lithotripsy (Calculase®, Karl Storz) using 200 and 365 micrometer fibres. Fragment extraction with 1.7 Fr nitinol baskets (N-gage, Cook). In cases of significant fragmented stone burden, the renal cavities were washed with low-pressure fluid irrigation using a ureteral access sheath, which was collected together with the stone fragments carried by the "mini-perc" sheath (Ultrax-x® 18Fr, Cook; Rusch, 14 Fr) placed under radiologic and endoscopic control at the level of the calyx-papilla selected for fragment drainage.the mean diameter for group A was 9.13 (range 5-13) mm and 20.25 (range 16-28) mm for group B. The overall mean operating time was 81 (range 30-160) min. Group A required 66.43±35.18 min. and group B 107.5±46.73 min. (p=0.006). The rate of absence of stones immediately after surgery was 83.2%, 93.1% at 3 months (95.6% for A and 83.3% for B; p=0.217). In no case was ureteral stenosis observed as a result of the use of ureteral access sheaths. In 7 group B patients (58.3%) with acute lithiasis and/or alteration in their pyelocaliceal anatomy, we performed active lavage of the renal cavities applying the aforementioned percutaneous technique. The mean post-surgery hospital stay was 2.1 (range 1-4) days. There were post-surgery complications (Clavien 1) in 7 patients (20%). Two patients required a second FURS.RIRS can be effective treatment for renal lithiasis1.5 cm. Lavage of the renal cavities helps to eliminate stone fragments, reducing the possibility of retreatment.

To study compliance in the medical treatment of glaucoma, its possible association with other factors, and quality of life of patients with glaucoma.Longitudinal prospective study of 60 patients with ocular hypertension or glaucoma who were treated with travoprost, or with a fixed combination of travoprost/timolol nightly. All subjects were given a Travalert(®) dosing aid and were reviewed after one and four months. Strict and relative compliance data were collected on each visit. The relationship between compliance and other variables was studied using univariate analysis. To analyse quality of life, patients were given self-assessment STAI anxiety questionnaires after the first and last visits.Relative compliance for the four months was significantly greater than the strict compliance (P=.001). In the group of least compliance the number of patients on treatment with combination therapy was significantly higher than those on monotherapy. In the lost cases, the number of men was significantly higher than women. No association was found in the other variables. The anxiety was similar to that in the normal population.Compliance is very important in the treatment of glaucoma, and our study provides objective data through the use of Travalert dosing aid with relative compliances of 70%. Patients with combined therapies have lower compliance than those on monotherapy.

Dermal melanocytosis refers to congenital or acquired lesions characterized by the presence of dendritic cells derived from melanocytes that migrate from the neural crest to the epidermis. The nevus of Ito develops in the territory supplied by the acromioclavicular nerve. Malignant transformation in dermal melanocytosis is extremely rare, with only isolated case reports; only 2 cases of malignant transformation of a nevus of Ito have been reported. We report a very rare case that is the third to be described in the literature. The patient was a 24-year-old man who presented with a subcutaneous nodule that had developed in the anterolateral region of the thorax over the previous 8 months. The nodule was located beneath a faint blue-gray macule with poorly defined borders. Biopsy of the nodule revealed malignant melanoma; biopsies of the adjacent skin lesion showed a diffuse proliferation of scattered melanocytes in a collagen stroma in the reticular dermis. A diagnosis of malignant transformation of a nevus of Ito was made after other possibilities were ruled out.

Erectile dysfunction (ED) leads to psychological disturbances, especially anxiety and loss of self-esteem. We try to understand the emotional changes, based on self-esteem and relationships in a group of Spanish men with ED after sildenafil treatment, with the use of the the SEAR questionnaire (Self-Esteem And Relationship).The patients recruited in Spain, where selected from an international, multicenter, randomized, parallel-group, double-blind, placebo-controlled, sildenafil study designed to assess self-esteem and relationships in men with ED. We compared the changes in the different domains of the SEAR questionnaire (Self-steem, sexual activity, self-confidence and general relationships) that was administered before and after treatment; the different domains of the IIEF was evaluated as well. We also calculated the correlation between changes in self-esteem domain of the SEAR questionnaire. The statistical study was based on an analysis of covariance of change in scores and a correlation analysis.The Spanish group of researchers included 119 patients. The erectile function domain score showed significantly greater improvement for the group of sildenafil. The difference in change in total mean score of the SEAR after treatment was 16.9 (95% CI 8.9, 24.8) for sildenafil over placebo (p=0.0001), with a significantly higher score improvement in all the domains of the SEAR for Sildenafil. There was a significant correlation between the changes in the domain of self-esteem of the SEAR and the IIEF erectile function domain for both treatment groups.Emotional improvement was confirmed in patients treated with sildenafil based on improved self-esteem, self-confidence and relationships. Changes in the IIEF erectile function domain correlate with the SEAR self-esteem domain.

Radiotherapy and androgen deprivation are an established treatment option for locally advanced prostate cancer. We evaluate outcomes in efficacy and toxicity for patients treated with this combined therapy at our institution.A retrospective study of 80 patients with locally advanced prostate cancer treated with radiotherapy combined with neo-adjuvant (2 months) and adjuvant (24 months) androgen deprivation. We studied the clinical variables and side effects. We evaluated treatment outcomes using PSA nadir and biochemical failure, and recorded acute and late gastrointestinal and urinary toxicity. We assessed the correlation between clinical variables and urinary toxicity by means of univariate and multivariate analyses (multiple logistic regression).The mean patient age was 68 ± 5.81 years; the initial PSA was 20.05 ± 16.27 ng/ ml and the mean prostate volume 43.7 ± 27.57 cc. The clinical stage was T3a in 33% and T3b in 66%. The Gleason score was7 in 39%, 7 in 46% and ≥8 in 15%. The mean follow-up was 44.4 months and biochemical failure was observed in 3 cases. Acute urinary toxicity was recorded in 90% of the patients (chronic in 35%) and acute gastrointestinal toxicity in 75% (late in 32%). In a univariate analysis, prostate volume and urinary symptoms were statistically correlated to acute and late urinary toxicity. Both prostate volume and urinary symptoms were independently associated with an increase in urinary toxicity in the logistic regression analysis.Hormone-radiotherapy is a valid option to locally treat advanced prostate cancer with optimal short-term outcomes, although it is not devoid of side effects. Prostate volume and urinary symptoms before treatment can predict genitourinary toxicity.

In the prevention for being overweight and for obesity, much attention is given to the influence of dietary factors, making the joint evaluation with other modifiable factors necessary.The aim of this project is to study the association between modifiable factors (physical activity, sedentary lifestyle, and dietary habits) with the prevalence of being overweight or obese in the youth population.Cross-Sectional study of 1283 school children between the ages of 3 and 16 years old, with measurements of the MBI, dietary habits, physical activity, sedentary lifestyle and family history of being overweight. Physical activity measured in MET was classified according to Pate criteria.22.4% of the boys and 32.9% of the girls were overweight. The presence of a BMI25 in parents multiplied by 2.4 the risk of being overweight in children (OR CI 95% 1.5-3.7). 63.6% of overweight boys meet physical activity recommendations compared with 52.2% of girls, although in their case, it was greater than the average (45%). Sedentary time was 141 minutes for men and 128 minutes for women, with more sedentary behaviors associated with being overweight, especially in girls over 12 years of age (66.7%). Consuming cereal (OR 0.8) and having five meals per day (OR 0.5) act as protective factors.In subjects with overweight, the levels of physical activity are close to those recommended levels, so which the values of a sedentary lifestyle together with dietary habits (if the parents have overweight) acquire a new relevance in intervention strategies of this problem.

To compare the efficiency and secondary effects of using 1% rimexolone or 0.1% dexamethasone as postoperative treatment for cataract surgery.A prospective study performed on a cohort of 37 patients undergoing cataract surgery by phacoemulsification with no intraoperative complications at the Hospital Clínico San Carlos, Madrid. After surgery, 19 of the patients were randomly assigned to receive topical 0.1% dexamethasone (DEX group) as inflammatory treatment and the remaining 18 subjects were treated with 1% rimexolone ( RIMEX group) following the same regime. Twenty four hours and one month after surgery, visual acuity, conjunctival hyperaemia, anterior chamber cells, anterior chamber flare, intraocular pressure, corneal thickness and macular edema were determined in each patient.The repeated measures test performed on 24 hours and 1 month data revealed a significant difference between the two treatments in terms of Tyndall (p = 0.001) and flare (p= 0.034) values; these variables being lower in the dexamethasone group. No differences were observed in the remaining variables examined.Rimexolone is as efficient and safe as dexamethasone for the treatment of patients undergoing cataract extraction.

Radical cystectomy in elderly is a controversial issue that increases importance overtime because average life span is growing.The purpose of our work was to analize the differences about perioperative and later outcomes between ages of patients with muscle-invasive bladder neoplasm treated with radical cystectomy.We retrospectively reviewed the records of patients who underwent radical cystectomy for muscle-invasive bladder cancer. Two age groups were compared:70-years-old at time of cystectomy (n = 55) andor = 70 years (n = 57).There was no difference between both age groups about: time of surgery, intraoperative complications (70 = 21,8%,or = 70 = 31,6%), postoperative mortality (70 = 3,6%,or = 70 = 8,8%), minor (70 = 18,2%,or = 70 = 26,3%) and major medical postoperative complications (70 = 7,3%,or = 70 = 8,8%), late outcomes as cancer-specific morby-mortality and actuarial overall survival stratified by patient age. The rate of major postoperative complications (70 = 23,6%,or = 70 = 43,9%) as well as the mean length of hospital stay (70 = 10,2,or = 70 = 15,2 days) differed significantly between the two age groups. Age and cardiovascular risk factors were independient predictive factors of mayor postoperative complications.Radical cystectomy could be performed in carefully selected elderly patients.