[Surgical pedagogy: towards a humanistic education perspective]. / Pedagogía quirúrgica: hacia una perspectiva de la educación humanista.

No Abstract available.

Iatrogenic affectation of ocular motility by immune checkpoint inhibitors.

Cancer therapy relies on new antitumoral drugs called immune checkpoint inhibitors (ICI), which produce long-lasting anti-tumor responses and lengthen survival, but cause autoimmune-type toxicity. The clinical characteristics induced by ICI are not well characterized to date and careful collection of clinical data is required to accurately define its safety profile. We conducted a literature search in the main clinical search engines to identify pharmacological ocular iatrogenic events of ICIs related to ocular motility. Four systematic reviews were found that included this type of ocular iatrogenesis as well as numerous isolated case reports. Reported adverse effects include: oculomotor paresis, optic neuropathy, optic atrophy, myastheniform syndromes, thyroid pseudo-orbitopathy, orbital apex syndrome, and hypophysitis. Most were managed without interruption or with partial interruption of cancer treatment. Aggressive systemic treatments were required for adequate management of ocular iatrogenic events. It is essential that the ophthalmologist become familiar with the new ICI oncological treatments, capable of causing severe and disabling motilidad ocular iatrogenesis for the patient. The communication of adverse effects and the report of the treatments used can help the most appropriate management of these patients. Research should be oriented towards complex differential diagnosis and to optimize decisions on cancer treatments.

Surgical training with phantoms in strabismus surgery.

BACKGROUND AND PURPOSE: Simulation in surgical learning responds to ethical and pragmatic needs. Our purpose is to describe the effects on surgical skills of conducting a surgical training workshop on strabismus surgery with phantoms. Concern for patient safety makes it necessary to consider the use of simulators (virtual and three-dimensional physical) and animal models that allow the applicant to safely practice the procedures before facing a real case. MATERIAL AND METHODS: Realization of a workshop with previous theoretical content and real practice with phantoms designed to simulate strabismus surgery (eyeball, 6 muscles, conjunctiva, eyelid and tenon capsule inserted in the skull) of real anatomical dimensions. Satisfaction survey and subjective evaluation of learning by the student and the expert tutor according to the Kirkpatrick evaluation model. RESULTS: Total, 100% of the 26 students attending two courses (15 students in one course and 11 students in another course) and 100% of the 3 tutors who participated in both courses completed the survey. 20 were resident doctors and 20 specialists in ophthalmology. The overall satisfaction of the students was 8.2 (±0.68). CONCLUSIONS: According to the results of the Kirkpatrick training actions evaluation survey, the perception of students and tutors is that training with phantoms in strabismus surgery can help improve the skills necessary for safe and independent practice. The ultimate goal being to improve patient safety.

Corticodependent bilateral trochleitis.

Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team.

Integral valorization of Acacia dealbata wood in organic medium catalyzed by an acidic ionic liquid.

In this work, a novel delignification process was proposed for the fractionation of invasive species such as Acacia dealbata wood. Organosolv process catalyzed with an acidic ionic liquid, 1-butyl-3-methylimidazolium hydrosulfate was evaluated to obtain cellulose-enriched solids and liquid fractions rich in hemicelluloses derived compounds and lignin. Under selected operating conditions (190 °C, 60% ethanol, 60 min of reaction time and 0.6 g 1-butyl-3-methylimidazolium hydrosulfate/g wood), high solubilization of lignin and hemicelluloses and cellulose recovery (87.5%, 88.7% and 88.3%, respectively), with a pulp yield of 43.1% were achieved. Moreover, 62.6 % of lignin was recovered by precipitation from the black liquor (composed mainly by 4.43 g xylose/L, 7.66 g furfural/L and 3.59 g acetic acid/L). In addition, enzymatic digestibility of delignified wood was also assayed. Overall, this work presents an alternative biorefinery scheme based in the use of environmentally friendly solvent and catalyst for selective fractionation of A. dealbata wood.

Corticodependent bilateral trochleitis. / Trocleítis bilateral corticodependiente.

Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team.

Ultrafast transient liquid assisted growth of high current density superconducting films.

The achievement of high growth rates in YBa2Cu3O7 epitaxial high-temperature superconducting films has become strategic to enable high-throughput manufacturing of long length coated conductors for energy and large magnet applications. We report on a transient liquid assisted growth process capable of achieving ultrafast growth rates (100 nm s-1) and high critical current densities (5 MA cm-2 at 77 K). This is based on the kinetic preference of Ba-Cu-O to form transient liquids prior to crystalline thermodynamic equilibrium phases, and as such is a non-equilibrium approach. The transient liquid-assisted growth process is combined with chemical solution deposition, proposing a scalable method for superconducting tapes manufacturing. Additionally, using colloidal solutions, the growth process is extended towards fabrication of nanocomposite films for enhanced superconducting properties at high magnetic fields. Fast acquisition in situ synchrotron X-ray diffraction and high resolution scanning transmission electron microscopy (STEM) become crucial measurements in disentangling key aspects of the growth process.

Theory, simulation and experiments for precise deflection control of radiotherapy electron beams.

Conventional radiotherapy is mainly applied by linear accelerators. Although linear accelerators provide dual (electron/photon) radiation beam modalities, both of them are intrinsically produced by a megavoltage electron current. Modern radiotherapy treatment techniques are based on suitable devices inserted or attached to conventional linear accelerators. Thus, precise control of delivered beam becomes a main key issue. This work presents an integral description of electron beam deflection control as required for novel radiotherapy technique based on convergent photon beam production. Theoretical and Monte Carlo approaches were initially used for designing and optimizing device´s components. Then, dedicated instrumentation was developed for experimental verification of electron beam deflection due to the designed magnets. Both Monte Carlo simulations and experimental results support the reliability of electrodynamics models used to predict megavoltage electron beam control.

Características Antropométricas por Posición de Juego en Mujeres Futbolistas Chilenas de la Región de Valparaíso, Chile / Anthropometric Attributes by Playing Position in Chilean Female Football Players From the Valparaiso Region, Chile

Participaron del estudio 76 mujeres futbolistas de la región de Valparaíso, las edades fluctuaron entre los 18 y 30 años. Fueron evaluados los equipos femeninos profesionales de los clubes Everton, Santiago Wanderers y San Luis de Quillota, las selecciones de la universidades de Valparaíso, Técnica Federico Santa María y Universidad Viña del Mar. Las posiciones de juego fueron distribuidas en arqueras (n= 8), defensas (n= 25), volantes (n= 24) y delanteras (n= 18). Para la evaluación de la composición corporal se utilizó el protocolo establecido por la International Society for the Advancement of Kinanthropometry. Para determinar el somatotipo de las futbolistas fue utilizado el modelo de Heath & Carter. Se fraccionó el peso corporal total a través del método pentacompartimental diseñado por Kerr. Los resultados demuestran un somatotipo promedio mesomorfo endomorfo, la distribución por equipos evidencia diferencias significativas en el mesomorfismo entre los equipos Everton y Universidad Viña del Mar (p<0,014). Entre las posiciones arquera y delantera existieron diferencias significativas en las variables peso (p<0,030) y endomorfia (p<0,050). No existieron diferencias en el porcentaje de tejido adiposo, tejido muscular, sumatoria de pliegues y estatura por posición de juego. En lo que respecta a la distribución por posición de juego, se evidencia un somatotipo meso endomorfo en las posiciones arquera y defensa, en las posiciones volantes y delanteras se aprecia un somatotipo mesomorfo endomorfo, esto demuestra una diferenciación del somatotipo entre posiciones de juego defensivas y ofensivas encontrando un mayor predominio de la endomorfia en las posiciones defensivas en comparación con las de ataque. Según el método SANOVA se concluye que las futbolistas evaluadas en este estudio presentaron características antropométricas similares, no habiendo diferencias significativas entre equipos universitarios y profesionales, ni por posición de juego.

Seventy-six female football players from the Valparaiso Region. Players´ age fluctuated between 18 and 30 years participated in this research. Female professional teams from Everton, Santiago Wanderers and San Luis de Quillota clubs, as well as the teams from Federico Santa María Technical University and Viña del Mar University were evaluated. Playing positions were: goalkeepers (n= 8), defenders (n= 25), attacking midfielders (n= 24) and strikers (n= 18). To measure body composition the protocol established by the International Society for the Advancement of Kinanthropometry was used, according to the restricted profile described by Drinkwater and Norton & Olds. The Heath and Carter method was used to determine the somatotype of the female football players. Total body mass was divided using Kerr´s Five-Way Fractionation method. Results show an average somatotype of mesomorph and endomorph. In the distribution by teams, the results showed significant differences of mesomorph between the Everton Club and the Viña del Mar University (p<0.014). Between the goalkeepers and the strikers there were significant differences regarding weight (p<0.030) and endomorph (p<0.050). No differences in the percentage of adipose tissue, muscle tissue, the sum of folds and height in relation to playing position were found. Regarding the distribution by playing position, the results showed a meso-endomorph somatotype for the goalkeepers and defenders, and a mesomorph endomorph somatotype for the attacking midfielders and strikers. This reveals a differentiation of somatotypes between offensive and defensive playing positions, finding a higher prevalence of the endomorph somatotype in defensive playing positions compared to the attack positions. Using the SANOVA method, the study concludes that the anthropometric attributes of the female football players evaluated are similar, with no significant differences between university teams and professional teams or by playing position.

Perfil antropométrico por posición de juego en handbolistas chilenos / Anthropometric profile in Chilean handball players according to playing position

El objetivo fundamental de la presente investigación fue determinar el perfil antropométrico y su relación con la capacidad de salto en jugadores de balonmano varones de la región de Valparaíso y de la Selección Chilena, esto en relación a su posición en el campo de juego. Se valoraron 74 jugadores de la categoría cadetes, cuyas edades fluctuaron entre los 14 y los 16 años, pertenecientes a los equipos: Club Italiano Villa Alemana, Club Italiano Quillota, Club Luterano, Club Viña del Mar, Club San José y Selección Chilena. Los resultados arrojaron que en cuanto a las variables antropométricas, la Selección Chilena y el Club Italiano Villa Alemana, son los que poseen los parámetros que más se asemejan a los requeridos a nivel competitivo dentro de esta categoría. Al hacer referencia a las variables antropométricas se estimó que, en todos los grupos estudiados, la masa adiposa se relacionó negativamente con la altura de salto alcanzada. Mientras que la masa muscular presentó una alta correlación con el rendimiento en salto en la mayoría de los equipos. Los índices de correlación evidenciaron que un menor porcentaje de masa grasa y mayor porcentaje de masa muscular favorecen la altura de salto alcanzada en todas las posiciones de juego. Queda de manifiesto que la relación masa adiposa y masa muscular es un indicador importante a la hora de determinar el rendimiento en la capacidad de salto en deportistas con características similares a las de este estudio.

The primary purpose of this research was to determine the relationship between the anthropometric profile and jump capacity of male handball players from the Fifth Region of Chile and the National Handball Team and their specific position in the playing field. In the evaluation 74 handball players participated from the following teams: Club Italiano Villa Alemana, Club Italiano Quillota, Club Luterano, Club Viña del Mar, Club San José and the National Handball Team. Participants were in the cadet category aged 14 ­ 16. The results showed that within anthropometric variables, players from the Chilean Handball Team and the Club Italiano Villa Alemana are the closest to fulfilling all the criteria required to reach high competitive levels in this category. In reference to anthropometric variables, fat mass proved to be negatively related to jump height reached in all groups tested, while muscle mass presented significant correlation with the jump capacity in most of the teams. Regarding the somatotype, results obtained agree with the theoretical referents. These establish that handball player's somatotype is more likely to be mesomorph. The correlation indexes demonstrate that a lower fat mass percentage and a higher muscle mass percentage enhance the jump capacity in all playing positions. It is clear now that fat mass and muscle mass are important indicators when determining the jump capacity performance in players with similar characteristics of the ones in this study. This research is important in setting comparative parameters in the selection process and sport specialization regarding anthropometric characteristics and jump capacity according to specific position of handball players in the cadet category.

¿Por qué puede ser difícil comprender qué es la TO? Una propuesta teórica desde cuatro perspectivas / Why could be difficult understand what is occupational therapy? A theorical proposal from four perspectives

El presente artículo es un ensayo desarrollado por cuatro terapeutas ocupacionales que en la actualidad desempeñan sus labores en dos universidades chilenas. Durante una mesa redonda realizada en el III Encuentro de Estudiantes de Terapia Ocupacional en Chile en el año 2014, y desde sus propios desarrollos teóricos, se reúnen para asumir el desafío de explicar por qué es tan difícil definir qué es la Terapia Ocupacional. Así, la discusión comienza con las propuestas realizadas por las mujeres pragmatistas, de principios del siglo XX, y los aportes para comprender los procesos de salud y enfermedad desde una perspectiva holística en contraposición a la visión dicotómica y reduccionista instalada por la ciencia neopositivista. Se prosigue con la propuesta ontológica de Heidegger sobre el “Ser y Tiempo” para la explicación de la ocupación y la Terapia Ocupacional, asumiendo un vacío ontológico en la historia de la profesión. Posteriormente se presentan los aportes que, desde la Teoría del Actor-red, ayudarían a responder la pregunta inicial, asumiendo que la dificultad estaría en la incapacidad de traducir y enrolar los propios desarrollos teóricos a otros actores. Finalmente se entrega una propuesta de posicionamiento epistemológico desarrollado inicialmente por Humberto Maturana y Francisco Varela, el que deriva hasta el paradigma de la complejidad, definido por Edgar Morin.

This article is the result of an essay developed by four occupational therapists that currently perform as academic at two Chilean universities. During a round table discussion, at the Third Chilean Meeting of Student Occupational Therapy in 2014, and from their own theoretical developments, they meet to take the challenge of explaining why it is so difficult to define what occupational therapy is. Thus, the discussion begins with the pragmatists women’s theorist of the early twentieth century and her contributions to understand the processes of health and disease from a holistic perspective as opposed to the dichotomous and reductionist point of view installed by neopositivism science. It continues with Heidegger’s ontological proposal of ‘Being and Time’ for explanation of occupation and occupational therapy, assuming an ontological gap in the history of the profession. Then, it presents the contributions from the Actor-Network Theory and how helps to answer the initial question, assuming that the difficulty would be the inability to translate and enroll themselves theoretical developments to other actors. Finally a proposal of epistemological positioning initially developed by Humberto Maturana and Francisco Varela, which derives to the paradigm of complexity, defined by Edgar Morin, is handed in.

Development of digestive tract and enzyme activities during the early ontogeny of the tropical gar Atractosteus tropicus.

Changes in digestive enzyme activity and histology were studied in Atractosteus tropicus embryos, larvae and juvenile periods. Alkaline protease, chymotrypsin, carboxypeptidase A, lipase and α-amylase were detected in all periods and gradually increased until reaching the maximum peak in juveniles; meanwhile, acid protease was first detected at 5 days after hatching (dah) when first feeding started and trypsin and leucine aminopeptidase activities were detected from 19 dah, their values being increased gradually until reaching a maximum value at 31 dah. Acid and alkaline phosphatase activities increased from yolk-sac absorption (3 dah) until day 31 after hatching. Zymogram for acid protease showed two bands in active forms (0.4 and 0.5 Rfs) from day 5 after hatching and a third protease form (0.3 Rf) that appears at 31 dah. Two active forms (26.3 and 24.9 kDa) were detected using SDS-PAGE alkaline proteases zymogram at 5 dah, and an additional active form (44.1 kDa) was detected at 7 dah. Regarding the histological development of the digestive system, the exocrine pancreas containing zymogen granules was already visible at 3 dah, whereas at 5 dah first gastric glands were already detected in the stomach. Between 7 and 9 dah, the digestive tract of A. tropicus resembled that of a juvenile specimen with a well-developed and short oesophagus, stomach divided into a glandular and non-glandular (pyloric) stomach, folded intestine with pyloric caeca and a well-developed spiral valve (posterior intestine). Considering this, larvae of A. tropicus are capable of digesting several foods from yolk absorption (3 dah), maximizing its activities at 15 dah, age at which the organisms maximize its capability to absorb nutrients from diets provided.

Comparison of haematopoietic stem cell engraftment through the retro-orbital venous sinus and the lateral vein: alternative routes for bone marrow transplantation in mice.

Bone marrow transplantation in mice is performed by intravenous administration of haematopoietic repopulating cells, usually via the lateral tail vein. This technique can be technically challenging to carry out and may cause distress to the mice. The retro-orbital sinus is a large area where there is a confluence of several vessels that provides an alternative route for intravenous access. Retro-orbital injection, although aesthetically unpleasant, can be performed rapidly without requiring mechanical restriction or heat-induced vasodilation. In addition, this technique can be easily learned by novice manipulators. This route of administration has been reported for use in bone marrow transplantation but there is no comparison of retro-orbital and tail vein injections reported for this specific purpose, although both routes have been compared for many other applications. Here, we provide for the first time a comprehensive comparison between tail vein and retro-orbital injections for two different bone marrow transplant scenarios in P3B and B6D2F1 mice. In both cases, no significant differences regarding donor engraftment were observed between mice transplanted using each of the techniques. Haematological counts and leukocyte subpopulation distribution were practically identical between both animal groups. Moreover, donor engraftment levels were less homogenous when cells were transplanted by tail vein injection, probably due to a higher risk of failure associated with this technique. All these data suggest that retro-orbital injection is a compelling alternative to conventional tail vein injection for bone marrow transplant in mice, providing similar and more homogenous haematopoietic reconstitution.

El ser y el tiempo: una posibilidad ontológica para la terapia ocupacional / Being and time: an ontological posibility for occupational therapy

El presente trabajo se propone navegar en las posibilidades que otorgan las ideas sobre el Ser y el Tiempo desarrolladas por Martin Heidegger, como punto de partida para una reflexión ontológica sobre la ocupación, coherente con el ejercicio de la Terapia Ocupacional. Con este propósito, se revisan y contrastan conceptos centrales de la propuesta del autor alemán con el proyecto ampliamente aceptado por la comunidad de Terapeutas Ocupacionales, la naturaleza ocupacional del ser humano de Ann Wilcock. La discusión, además de centrarse en la invitación a los y las terapeutas ocupacionales a profundizar en este tema, se encuentra con una evidente sincronía entre el dasein hedeggeriano y la ocupación, aspectos que resuenan en la noción de becoming de Wilcock.

The present paper pretends to sail through the posibilities given by the notions about Being and Time developed by Martin Heidegger, as a starting point for an ontological reflection about occupation, coherent with the Occupational Therapy practice. For this purpose, core concepts of the German author are revised and contrasted with the project widely accepted in the occupational therapists community, the occupational nature of the human being by Ann Wilcock. The discussion, in addition to focusing on the invitation to the occupational therapists to go deeper into the topic, encounters an evident synchrony between Heidegger’s dasein and occupation, both aspects that resonate in Wilcock’s notion of becoming.

Measurement of the survival probabilities for hot fusion reactions.

We have studied the fission-neutron emission competition in highly excited (274)Hs (Z=108) (where the fission barrier is due to shell effects) formed by a hot fusion reaction. Matching cross bombardments ((26)Mg+(248)Cm and (25)Mg+(248)Cm) were used to identify the properties of first chance fission of (274)Hs. A Harding-Farley analysis of the fission neutrons emitted in the (25)Mg,26+(248)Cm was performed to identify the prescission and postscission components of the neutron multiplicities in each system. (Γn/Γt) for the first chance fission of (274)Hs (E*=63 MeV) is 0.89±0.13; i.e., ∼90% of the highly excited nuclei survive. The high value of that survival probability is due to dissipative effects during deexcitation. A proper description of the survival probabilities of excited superheavy nuclei formed in hot fusion reactions requires consideration of both dynamic and static (shell-related) effects.

Laparoscopic pyeloplasty: technique and results in 80 consecutive patients.

OBJECTIVE: To present our long-term results with the Anderson-Hynes laparoscopic pyeloplasty, performed by a single surgeon. MATERIAL AND METHODS: Between August 1999 and December 2009, 79 patients (80 procedures) were operated for primary ureteropelvic junction obstruction. We use the Anderson-Hynes technique by a transperitoneal approach. Patients were evaluated with Ultrasound, Excretory urography and dynamic renal scintigraphy (Mag-3). The perioperative characteristics, complications and results were reviewed. RESULTS: We performed 80 laparoscopic pyeloplasties in 79 patients. Mean operative time was 93.2 minutes (60-180). Crossing vessels were found in 38 of 82 (46.3%) renal units. Kidney abnormalities occurred in 4 patients (1 double ureteropelvic system, one associated retrocaval ureter, 1 horseshoe kidney and one pelvic kidney). Complications occurred in 5 procedures (6.5%): an immediately postoperative bleeding (Clavien 3b), 1 cecal volvulus (Clavien 3b), 1 urosepsis (Clavien 4th) and 1 urinary fistula (Clavien 3a). In this series there was neither mortality nor conversion to open surgery There was recurrence in 3 out of 80 patients (3.7%). They were resolved as follows: 1 percutaneous antegrade endopyelotomy, 1 secondary laparoscopic pyeloplasty and 1 robotic pyeloplasty. There was a 96.3%. of primary overall success rate. CONCLUSIONS: Our results show that laparoscopic pyeloplasty compares favorably with the result achieved by open surgery. We believe that laparoscopic pyeloplasty is a good surgical alternative for the management of primary ureteropelvic junction obstruction.

Cómo optimizar la seguridad en el uso de medicamentos en urgencia / How to optimize the safe use urgency medicines

Medication errors are defined as any preventable event that may cause harm to the patient or lead to inappropriate medication use. There are factors that determine the occurrence of medication errors in health services, such as: insufficient knowledge of patient care load, fast speed in care, variety and complexity of the routes of drug administration, among others. There are multiple studies in Emergency Departments where increased incidence of medication errors where observed. In our Emergency Department the frequency of medication errors was established at 29.4 percent. To avoid these errors, prevention strategies were generated depending on the type of error. As specific strategies in our emergency department we have assured the presence of a clinical pharmacist in the health team, local protocols for indications have been created and ongoing training of health personnel has been mandatory. The objective of these measures is to ensure quality and safety of patient care. We recognize that errors will occur due to the type of care we provide, and therefore we should implement measures at hand to reduce them...

Clinical, Cytogenetic, and Biochemical Analyses of a Family with a t(3;13)(q26.2;p11.2): Further Delineation of 3q Duplication Syndrome.

Chromosomal abnormalities that result in genomic imbalances are a major cause of congenital and developmental anomalies. Partial duplication of chromosome 3q syndrome is a well-described condition, and the phenotypic manifestations include a characteristic facies, microcephaly, hirsutism, synophrys, broad nasal bridge, congenital heart disease, genitourinary disorders, and mental retardation. Approximately 60%-75% of cases are derived from a balanced translocation. We describe a family with a pure typical partial trisomy 3q syndrome derived from a maternal balanced translocation t(3;13)(q26.2;p11.2). As the chromosomal rearrangement involves the short arm of an acrocentric chromosome, the phenotype corresponds to a pure trisomy 3q26.2-qter syndrome. There are 4 affected individuals and several carriers among three generations. The report of this family is relevant because there are few cases of pure duplication 3q syndrome reported, and the cases described here contribute to define the phenotype associated with the syndrome. Furthermore, we confirmed that the survival until adulthood is possible. This report also identified the presence of glycosaminoglycans in urine in this family, not related to the chromosomal abnormality or the phenotype.

Laparoscopic surgery of vesicoureteral reflux: an experience in 42 patients with the Lich-Gregoir extravesical technique.

INTRODUCTION: Vesico-ureteral reflux (VUR) is a common congenital anomaly of the urinary tract in the pediatric population, existing controversy regarding its management. Patients selected for treatment options are offered, from endoscopic injection of substances sub-ureteral to ureteral reimplantation surgery. OBJECTIVE: To evaluate the use of the laparoscopic surgical technique for the treatment of vesico-ureteral reflux, with an analysis of the procedure, results and complications. MATERIAL AND METHODS: We evaluated a series of 50 ureteral units in 42 patients, who undergoing laparoscopic transperitoneal ureteral reimplant, using the classic technique of Lich-Gregoir detrusorrafia. RESULTS: The mean operative time was 74 min. There were no intraoperative nor immediate postoperative. At longer follow-up VUR was cured in all cases. CONCLUSIONS: Laparoscopic surgery is an effective alternative in the surgical treatment of vesico-ureteral reflux, with results comparable to open surgery techniques and over sub-ureteral injection techniques.

Advanced Parkinson's disease: clinical characteristics and treatment. Part II.

INTRODUCTION: Many patients who have had Parkinson's disease (PD) for several years will present severe motor fluctuations and dyskinesias which require more aggressive therapies. The different approaches which are now available include deep brain stimulation of the subthalamic nucleus or medial globus pallidus, subcutaneous infusion of apomorphine, and intestinal infusion of levodopa-carbidopa. OBJECTIVE: To define the indications and results for the 3 available therapies for advanced PD. DEVELOPMENT: Exhaustive review of the literature concerning the indications and results of deep brain stimulation, subcutaneous apomorphine infusion and duodenal infusion of levodopa/carbidopa gel to treat patients with advanced Parkinson disease. CONCLUSIONS: Although numerous studies have confirmed the efficacy of the 3 different therapies in advanced PD, there are no comparative studies that would allow us to define the best candidate for each technique.