RESUMEN
OBJECTIVE: The role of atherosclerosis in abdominal aortic aneurysm (AAA) pathogenesis is controversial. The aim of this study was to compare AAA growth in patients who did and did not have concurrent athero-occlusive disease (AOD). METHODS: Patients with an AAA measuring 35 - 49 mm in maximum diameter were recruited as part of the TElmisartan in the management of abdominal aortic aneurysm (TEDY) trial. TEDY participants who had infrarenal aortic volume and orthogonal diameter assessed by computed tomography at entry and at least one other time point during the trial (12 and/or 24 months) were included. AOD was defined by prior diagnoses of coronary heart disease, stroke, or peripheral arterial disease or an ankle brachial pressure index < 0.90. The increase in AAA volume and diameter from entry for participants who did and did not have AOD was assessed using linear mixed effects models; 131 of the 210 participants recruited to TEDY were included. RESULTS: In an unadjusted analysis, the mean (95% confidence interval) annual increases in AAA volume and diameter for participants with AOD were 3.26 (0.82 - 5.70) cm3 and 0.70 (0.19 - 1.22) mm slower than those without AOD, p = .008 and .007 respectively. The association between AOD and significantly slower AAA growth was maintained after adjusting for risk factors and medications, significantly unequally distributed between participants with and without an AOD diagnosis. CONCLUSION: In an exploratory analysis of a selective cohort from the TEDY trial, AOD was associated with slower AAA growth. Validation of these findings in other cohorts is needed.
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Aneurisma de la Aorta Abdominal , Enfermedad Coronaria , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/patología , Humanos , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
Urosepsis can progress toward severe sepsis, septic shock, and, ultimately, death. Rapid antimicrobial susceptibility testing is crucial to decrease mortality and morbidity. This report shows that isothermal microcalorimetry can provide an antibiogram within 7 h with a sensitivity of 95% and specificity of 91% using Vitek-2 system as a reference.
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Calorimetría/métodos , Pruebas de Sensibilidad Microbiana/métodos , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiología , Humanos , Sensibilidad y Especificidad , TiempoRESUMEN
PURPOSE: Isothermal microcalorimetry (IMC) has recently been reported as a new method to rapidly detect urinary tract pathogens (UTP). However, further application of microcalorimetry in the clinical setting requires a standardized procedure. An important step toward such standardization is to use a reproducible growth medium. In this study, we investigated the potential of artificial urine in combination with microcalorimetry for detection of common UTP. METHODS: A microcalorimeter equipped with 48 channels was used. Detection was accomplished, and growth was monitored for four bacterial strains in artificial urine at 37 °C by measuring metabolic heat flow (µW = µJ/s) as a function of time. The strains were Escherichia coli, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus aureus. RESULT: Bacterial growth was detected after 3-32 h with decreasing inoculums down to 1 CFU. The gram-negative strains grew and were detected faster than their gram-positive counterparts. The growth rates the different strains were 0.75 ± 0.11 for E. coli, 0.74 ± 0.10 for E. faecalis, 1.31 ± 0.04 for P. mirabilis, and 0.56 ± 0.20 for S. aureus. The shape of individual heat flow curves was characteristic for each species independent of its initial concentration. CONCLUSIONS: IMC allows rapid detection of UTP in artificial urine. Clearly, different heat flow patterns enable accurate pathogen differentiation. UTP detection after only 4 h is realistic. The rapid detection of UTP tested in standardized artificial urine proves the diagnostic potential of IMC and warrants further microcalorimetric studies in the clinical setting of urinary tract infections.
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Calorimetría/normas , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiología , Orina/microbiología , Animales , Enterococcus faecalis/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Humanos , Pruebas de Sensibilidad Microbiana , Proteus mirabilis/aislamiento & purificación , Estándares de Referencia , Staphylococcus aureus/aislamiento & purificación , Infecciones Urinarias/orinaRESUMEN
PURPOSE: Catheter-associated bacteriuria (CAB) with transurethral catheters is almost inevitable. Suprapubic catheters (SPCs) are widely considered to decrease the risk of CAB. However, SPCs are implants similarly prone to microbial biofilm formation. The spectrum of colonising pathogens has not been investigated. The aim of this prospective study was: (1) to assess the diversity of microbial suprapubic catheter colonisation (MSPCC), (2) to identify risk factors and (3) to investigate its association with CAB and catheter-associated urinary tract infection (CA-UTI). METHODS: A total of 218 SPCs from 112 patients were studied. Urine specimens were obtained after device replacement or removal. Sonication was performed to dislodge adherent microorganisms. Data of patient sex, age, indwelling time, and underlying disease were recorded. RESULTS: Sonicate-fluid culture (SFC) detected MSPCC in 95 %. Increasing indwelling time correlated with MSPCC (p < 0.05). Negative SFC was more frequent when antibiotic prophylaxis was applied at time of catheter placement (15 vs. 2 %, p < 0.05). Most commonly isolated were Enterobacteriaceae (45.8 %), followed by Enterococcus spp. (25.7 %) and Pseudomonas aeruginosa (10.3 %). CAB and CA-UTI were observed in 95 and 11 %, respectively. CONCLUSIONS: This study provides the first analysis of MSPCC. Indwelling time increases, whereas antibiotic prophylaxis decreases the risk of MSPCC. The spectrum of pathogens is comparable to the one obtained from urethral catheter biofilms. Urine specimens could not demonstrate the microbial diversity of MSPCC. SPCs are not preferable to urethral catheters to reduce CAB. Whether the risk of CA-UTI could be minimised by SPCs remains to be clarified.
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Bacteriuria/epidemiología , Biopelículas/crecimiento & desarrollo , Infecciones Relacionadas con Catéteres/epidemiología , Catéteres de Permanencia/microbiología , Enterobacteriaceae/fisiología , Enterococcus/fisiología , Infecciones Relacionadas con Prótesis/epidemiología , Pseudomonas aeruginosa/fisiología , Profilaxis Antibiótica , Bacteriuria/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Enterobacteriaceae/aislamiento & purificación , Enterococcus/aislamiento & purificación , Femenino , Humanos , Incidencia , Masculino , Estudios Prospectivos , Infecciones Relacionadas con Prótesis/prevención & control , Pseudomonas aeruginosa/aislamiento & purificación , Hueso Púbico , Estudios Retrospectivos , Factores de Riesgo , Cateterismo Urinario/instrumentación , Infecciones Urinarias/epidemiología , Infecciones Urinarias/prevención & controlRESUMEN
BACKGROUND: We recently established the rationale that NRBP1 (nuclear receptor binding protein 1) has a potential growth-promoting role in cell biology. NRBP1 interacts directly with TSC-22, a potential tumor suppressor gene that is differently expressed in prostate cancer. Consequently, we analyzed the role of NRBP1 expression in prostate cancer cell lines and its expression on prostate cancer tissue microarrays (TMA). METHODS: The effect of NRBP1 expression on tumor cell growth was analyzed by using RNAi. NRBP1 protein expression was evaluated on two TMAs containing prostate samples from more than 1,000 patients. Associations with clinico-pathological features, the proliferation marker Ki67 and survival data were analyzed. RESULTS: RNAi mediated silencing of NRBP1 expression in prostate cancer cell lines resulted in reduced cell growth (P < 0.05). TMA analysis revealed NRBP1 protein expression in benign prostate hyperplasia in 6% as compared to 60% in both, high-grade intraepithelial neoplasia and prostate cancer samples. Strong NRBP1 protein expression was restricted to prostate cancer and correlated with higher expression of the proliferation marker Ki67 (P < 0.05). Further, patients with strong NRBP1 protein expression showed poor clinical outcomes (P < 0.05). Analysis of matched localized cancer tissues before and after castration revealed that post-therapy-related repression of NRBP1 expression was significantly associated with better overall survival. CONCLUSIONS: We demonstrate that expression of NRBP1 is up-regulated during the progression of prostate cancer and that high NRBP1 expression is linked with poor prognosis and enhanced tumor cell growth.
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Adenocarcinoma/patología , Expresión Génica , Neoplasias de la Próstata/patología , Receptores Citoplasmáticos y Nucleares/genética , Proteínas de Transporte Vesicular/genética , Adenocarcinoma/genética , Adenocarcinoma/metabolismo , Adenocarcinoma/mortalidad , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Finlandia/epidemiología , Humanos , Antígeno Ki-67/metabolismo , Masculino , Persona de Mediana Edad , Pronóstico , Prostatectomía , Hiperplasia Prostática/epidemiología , Hiperplasia Prostática/genética , Hiperplasia Prostática/metabolismo , Hiperplasia Prostática/patología , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/mortalidad , Interferencia de ARN , ARN Interferente Pequeño/administración & dosificación , ARN Interferente Pequeño/genética , Receptores Citoplasmáticos y Nucleares/metabolismo , Tasa de Supervivencia , Suiza/epidemiología , Análisis de Matrices Tisulares , Proteínas de Transporte Vesicular/metabolismoRESUMEN
UNLABELLED: What's known on the subject? and What does the study add? Microcalorimetry has been applied in several microbiological studies, but never in a clinical urological context. In addition, basic knowledge on the growth of urinary pathogens in urine is still scarce and data regarding the growth rate of many urinary pathogens in urine are still not available. The study demonstrates that this innovative application of microcalorimetry is useful in (i) investigating the growth of urinary pathogens in sterilized urine and (ii) as a rapid tool for diagnosis of urinary infection as well as for further identification of the causative infectious agent. OBJECTIVE: To investigate the value of isothermal microcalorimetry (IMC) in the detection and differentiation of common urinary tract pathogens in urine. IMC is a non-specific analytical tool for the measurement of heat in the microwatt range. PATIENTS AND METHODS: A microcalorimeter equipped with 48 channels was used. Detection was accomplished, and growth was monitored for four bacterial strains in sterilized urine at 37 °C by measuring metabolic heat flow (µW = µJ/s) as a function of time. The strains were Escherichia coli, Proteus mirabilis, Enterococcus faecalis and Staphylococcus aureus. RESULTS: Bacterial growth was detected after 3.1 to 17.1 h with decreasing inocula. The detection limit was 1 colony-forming unit (CFU)/mL for E. coli, 10 CFU/mL for P. mirabilis and E. faecalis and 10(3) CFU/mL for S. aureus. The total heat was highest in P. mirabilis ranging from 10 to 12 J, followed by E. coli (3-4 J), S. aureus (2-3 J) and E. faecalis (1.3-1.5 J). The shape of the heat flow curves was characteristic for each species independent of its initial concentration. CONCLUSIONS: IMC allows rapid detection of bacteriuria, much faster than conventional culture. Urinary tract pathogen detection after only 3.1 h is realistic. Clearly different heat flow patterns enable accurate pathogen differentiation. Due to expeditious identification of urine samples that contain only low colony counts (i.e. less than 10(3) CFU/mL), IMC may become a valuable screening tool for detecting the presence of significant bacteriuria.
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Bacterias/aislamiento & purificación , Calorimetría/métodos , Orina/microbiología , Técnicas Bacteriológicas/métodos , Humanos , Factores de TiempoRESUMEN
Accurate prognostic parameters in prostate biopsies are needed to better counsel individual patients with prostate cancer. We evaluated the prognostic impact of morphologic and immunohistochemical parameters in preoperative prostate cancer biopsies. A consecutive series of prostate biopsies of 279 men (72% with clinical stage T1c and 23% with T2) who subsequently underwent radical prostatectomy was prospectively analysed for Gleason score, number and percentage of positive cores (NPC, PPC), total percentage of biopsy tissue with tumour (TPT), maximum tumour percentage per core (MTP), and expression of Ki67, Bcl-2 and p53. All biopsy features were significantly associated with at least one feature of the radical prostatectomy specimen. pT stage was independently predicted by PSA, seminal vesicle invasion by Ki67 LI, positive margins by PSA and MTP, large tumour diameter by PSA and PPC, and Gleason score by biopsy Gleason score, MTP, and Ki67 LI, respectively. Biopsy Gleason score, NPC (1 vs. >1), TPT (<7 vs. >or=7%), and Ki67 LI (<10 vs. >or=10%) were significant predictors of biochemical recurrence after radical prostatectomy (p < 0.01, each). KI67 LI was the only independent prognostic factor in case of a low TPT (<7%) or low Gleason score (<7), the hazard ratio being 6.76 and 6.44, respectively. In summary, preoperative Gleason score, NPC, TPT and Ki67 LI significantly predict the risk of recurrence after radical prostatectomy, and Ki67 is an independent prognosticator in biopsies with low-volume or low-grade prostate cancer. Analysis of Ki67 LI in these biopsies may help to better identify patients with clinically insignificant prostate cancer.
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Biomarcadores de Tumor/metabolismo , Antígeno Ki-67/metabolismo , Recurrencia Local de Neoplasia/diagnóstico , Cuidados Preoperatorios , Prostatectomía , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/patología , Adulto , Anciano , Biopsia con Aguja , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/metabolismo , Estadificación de Neoplasias , Pronóstico , Estudios Prospectivos , Neoplasias de la Próstata/cirugía , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Medición de Riesgo , Factores de Riesgo , Proteína p53 Supresora de Tumor/metabolismoRESUMEN
Molecular markers reliably predicting failure or success of Bacillus Calmette-Guérin (BCG) in the treatment of nonmuscle-invasive urothelial bladder cancer (NMIBC) are lacking. The aim of our study was to evaluate the value of cytology and chromosomal aberrations detected by fluorescence in situ hybridization (FISH) in predicting failure to BCG therapy. Sixty-eight patients with NMIBC were prospectively recruited. Bladder washings collected before and after BCG instillation were analyzed by conventional cytology and by multitarget FISH assay (UroVysion, Abbott/Vysis, Des Plaines, IL) for aberrations of chromosomes 3, 7, 17 and 9p21. Persistent and recurrent bladder cancers were defined as positive events during follow-up. Twenty-six of 68 (38%) NMIBC failed to BCG. Both positive post-BCG cytology and positive post-BCG FISH were significantly associated with failure of BCG (hazard ratio (HR)= 5.1 and HR= 5.6, respectively; p < 0.001 each) when compared to those with negative results. In the subgroup of nondefinitive cytology (all except those with unequivocally positive cytology), FISH was superior to cytology as a marker of relapse (HR= 6.2 and 1.4, respectively). Cytology and FISH in post-BCG bladder washings are highly interrelated and a positive result predicts failure to BCG therapy in patients with NMIBC equally well. FISH is most useful in the diagnostically less certain cytology categories but does not provide additional information in clearly malignant cytology.
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Adyuvantes Inmunológicos/uso terapéutico , Vacuna BCG/uso terapéutico , Carcinoma Papilar/diagnóstico , Hibridación Fluorescente in Situ/estadística & datos numéricos , Neoplasias de la Vejiga Urinaria/diagnóstico , Administración Intravesical , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/tratamiento farmacológico , Carcinoma in Situ/genética , Carcinoma Papilar/tratamiento farmacológico , Carcinoma Papilar/genética , Aberraciones Cromosómicas , Citodiagnóstico , ADN de Neoplasias/análisis , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/genética , Pronóstico , Estudios Prospectivos , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/genéticaRESUMEN
OBJECTIVE: To evaluate the safety, efficacy and short-term outcome of a new 980 nm high-intensity diode (HiDi) laser (Limmer Laser, Berlin, Germany) system in comparison to the diode-pumped solid-state laser high-performance system (HPS; GreenLight(TM), AMS, Minnetonka, MI, USA) for treating benign prostatic hyperplasia (BPH) in a prospective non-randomized single-centre study. PATIENTS AND METHODS: From February to September 2007, 117 consecutive patients with lower urinary tract symptoms secondary to BPH were included; 62 patients were treated with 120-W HPS laser vaporization and 55 with 980-nm HiDi laser ablation of the prostate. We evaluated perioperative variables, and complications during and after surgery. Patients presenting for follow-up completed the International Prostate Symptom Score, and had their maximum urinary flow rate and postvoid residual urine volume measured. RESULTS: The mean (sd) age of the patients was 72.3 (8.8) years (HiDi) and 73.1 (10.8) years (HPS), with a mean preoperative prostate volume of 64.7 (29.7) and 67.4 (46.9) mL, respectively. The mean operative duration was comparable, at 56.4 (20.2) and 62.7 (36.3) min, respectively, whereas the mean energy delivery was significantly higher with the diode laser, at 313 (132) vs 187 (129) kJ (P < 0.001). For patients treated with the HPS the rate of visual impairment from bleeding was higher (0% vs 12.9%, P < 0.01), as was prostate capsule perforation (0% vs 4.8%, P > 0.05). Soon after surgery the rate of dysuria (23.6% vs 17.7%, P > 0.05) and transient urge incontinence (7.3% vs 0%; P < 0.05) was higher for the HiDi laser. During the follow-up there were higher rates of bladder neck stricture (14.5% vs 1.6%, P < 0.01), re-treatment (18.2% vs 1.6%, P < 0.01) and stress urinary incontinence (9.1% vs 0%; P < 0.05) for the HiDi laser group. CONCLUSION: Both systems investigated provide good tissue ablative properties. The HiDi laser at 980 nm is more favourable in terms of haemostasis. The penetration depths, resulting in coagulation necrosis and leading to increased re-treatment, bladder neck stricture and incontinence rates, were higher with the HiDi laser.
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Terapia por Láser/métodos , Láseres de Estado Sólido/uso terapéutico , Hiperplasia Prostática/cirugía , Prostatismo/cirugía , Anciano , Anciano de 80 o más Años , Métodos Epidemiológicos , Humanos , Terapia por Láser/efectos adversos , Terapia por Láser/normas , Láseres de Estado Sólido/efectos adversos , Láseres de Estado Sólido/normas , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/complicaciones , Prostatismo/etiología , Resultado del TratamientoRESUMEN
OBJECTIVES: To evaluate the intermediate-term clinical efficacy and the rate of complications in 80 W photoselective vaporization of the prostate (PVP) with the potassium-titanyl-phosphate laser (Greenlight, (AMS, Minnetonka, MN, USA) compared with transurethral resection of the prostate (TURP) in a prospective non-randomised two-centre study. PATIENTS AND METHODS: From December 2003 to August 2006, 396 patients (PVP 269, TURP 127) with lower urinary tract symptoms secondary to benign prostatic hyperplasia were included in the study. There was a significant difference in mean age (72 years for PVP vs 68 for TURP, P = 0.001). Patients were therefore stratified in age categories (<70, 70-80, >80 years) and compared for perioperative variables, functional outcome and complications, with a follow-up of up to 24 months. RESULTS: The mean prostate size was greater (overall, 62 vs 48 mL, P < 0.001) and mean operative duration longer (overall 72 vs 53 min; P = 0.001) for PVP in all age categories. The rate of intraoperative bleeding (3% vs 11%), blood transfusions (0% vs 5.5%) and capsule perforations (0.4% vs 6.3%), and early postoperative clot retention (0.4% vs 3.9%) was significantly lower for PVP. Hospitalization time was significantly shorter in the PVP group for patients aged <70 years (3.0 vs 4.7 days) and 70-80 years (4.0 vs 5.0 days; P = 0.001). The improvement of peak urinary flow rate was higher after TURP for any age category. The International Prostate Symptom Score and postvoid residual volume during the follow-up showed no significant difference. After 12 months the overall prostate size reduction was 63% (-30 mL) after TURP and 44% (-27 mL) after PVP. The rate of repeat TURP/PVP was higher in the PVP group (6.7% vs 3.9%, not significant) within the follow-up of up to 2 years. The incidence of urethral and bladder neck strictures was comparable. CONCLUSIONS: PVP was more favourable in terms of perioperative safety. Although patients assigned for PVP were older and had larger prostates, PVP resulted in a similar functional outcome. Further follow-up is needed to draw final conclusions about the long-term efficacy of PVP.
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Terapia por Láser/métodos , Láseres de Estado Sólido/uso terapéutico , Próstata/cirugía , Hiperplasia Prostática/cirugía , Prostatismo/cirugía , Resección Transuretral de la Próstata/métodos , Anciano , Anciano de 80 o más Años , Humanos , Terapia por Láser/efectos adversos , Láseres de Estado Sólido/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Próstata/patología , Hiperplasia Prostática/complicaciones , Prostatismo/etiología , Resección Transuretral de la Próstata/efectos adversos , Resultado del Tratamiento , UrodinámicaRESUMEN
Acute ureteral colic presents with a complex of acute and characteristic flank pain that usually indicates the presence of a stone in the urinary tract. Diagnosis and management of renal colic have undergone considerable evolution and advancement in recent years. The application of noncontrast helical computed tomography (CT) in patients with suspected ureteral colic is one major advance in the primary diagnostic process. The superior sensitivity and specificity of helical CT allow ureterolithiasis to be diagnosed without the potential side effects of contrast media. Initial management is based on three key concepts: (A) rational and fast diagnostic process (B) effective pain control (C) and understanding of the impact of stone location and size on the natural course of the disease and definitive urologic management. These concepts are discussed in this review with reference to contemporary literature.
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Cólico/diagnóstico por imagen , Tomografía Computarizada Espiral , Enfermedades Ureterales/diagnóstico por imagen , Urografía , Enfermedad Aguda , Analgésicos/efectos adversos , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Cólico/terapia , Terapia Combinada , Humanos , Laparotomía , Litotricia , Nefrostomía Percutánea , Sensibilidad y Especificidad , Cálculos Ureterales/diagnóstico por imagen , Enfermedades Ureterales/terapia , UreteroscopíaRESUMEN
INTRODUCTION: Nephrectomy for autosomal dominant polycystic kidney disease (ADPKD) has been reported to have significant morbidity and mortality. Because of the large kidney size, laparoscopic nephrectomy is technically demanding and there have been only few reports on this subject. We describe our retroperitoneoscopic technique and review the literature. METHODS: Retroperitoneoscopic nephrectomy was performed in 2 patients. A four-port retroperitoneal access was used, after hilar control the kidney was freed and extracted. RESULTS: The mean operative time was 155 min, the mean intraoperative blood loss was 125 ml. There were no intraoperative complications. A postoperative retroperitoneal hematoma in 1 of the patients was managed conservatively with transfusion. CONCLUSION: Retroperitoneoscopic nephrectomy for ADPKD is feasible. The main advantages of this technique compared to transperitoneal laparoscopy are the quick and easy access to the hilar vessels even in large polycystic kidneys and the strict extraperitoneal route.
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Nefrectomía/métodos , Riñón Poliquístico Autosómico Dominante/cirugía , Adulto , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Espacio RetroperitonealRESUMEN
BACKGROUND: The aim of this study was to evaluate the early postoperative pain and pain management after standard open (ODN), hand-assisted laparoscopic (HLDN) and retroperitoneoscopic (RDN) donor nephrectomy. METHODS: The visual analogue scale (VAS) was determined twice a day in 203 donors during the first five days after nephrectomy. RESULTS: Mean VAS was significantly lower after RDN and HLDN than after ODN on day 2 (p=0.004) and days 3-5 (p<0.001). After RDN, "no pain" (VAS=0) was reported significantly earlier than after ODN. Irrespective of the technique used and the pain management, all donors reported significantly higher VAS in the morning. Opiates were administered for a significantly shorter average time period after RDN than after ODN (p=0.005). Cumulative morphine equivalent doses were higher after ODN than after RDN (p=0.001). Mean VAS reported after HLDN and RDN was similar. CONCLUSIONS: In summary, RDN and HLDN were clearly associated with much less early pain than ODN, independently of the used pain management.
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Laparoscopía/efectos adversos , Nefrectomía/efectos adversos , Nefrectomía/métodos , Dolor/tratamiento farmacológico , Dolor/fisiopatología , Donantes de Tejidos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Narcóticos/farmacología , Narcóticos/uso terapéutico , Estudios Retrospectivos , Factores de TiempoRESUMEN
Urinary cytology is limited by high interobserver variability in the evaluation of cells with little atypia. We set up an online quiz on urinary cytology and tested the performance of 246 international participants. The quiz consisted of still images of 42 urinary specimens with equivocal morphologic features and 10 control cases with an unequivocal cytologic diagnosis. The nature of the cells on the 292 quiz images had been verified by multitarget fluorescence in situ hybridization in addition to the information obtained by cystoscopy, clinical follow up, and/or histologic examination. The original quiz cases and the percentage of answers given by the participants can be viewed at: http://kathrin.unibas.ch/urinzyto/. High-grade cancers were diagnosed correctly in 76.0% and low-grade cancers in only 33.9%. Remarkably, 54.5% of all participants misclassified decoy cells as malignant. This study shows that large-scale international online quizzes may be used to find educational deficits in cytopathology.
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Clasificación/métodos , Citodiagnóstico , Telepatología , Urinálisis , Orina/citología , Enfermedades Urológicas/diagnóstico , Competencia Clínica , Errores Diagnósticos , Educación Médica Continua , Evaluación Educacional , Escolaridad , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Enfermedades Urológicas/orinaRESUMEN
The canton of Basel-Stadt was the only canton in Switzerland which introduced drinking water fluoridation (DWF) at 1 ppm (mg/l). All other cantons have relied on fluoridated domestic salt at 250 ppm F as the main vehicle for basic fluoride exposure. It has been suggested that persons living and working in the DWF areas or persons commuting to the DWF areas may be exposed to higher than optimal doses of fluoride. The objective of this present study was to determine the urinary fluoride excretion of adults living and or working in neighboring areas of either salt or water fluoridation. In this study, 24-hour urine was collected from 69 healthy subjects and tested for fluoride concentration. The mean fluoride concentration for all participants was 0.55 +/- 0.25 ppm (mg/l) ranging from 1.14 to 0.09 ppm. The mean fluoride excretion was 0.95 +/- 0.47 mg F/d ranging from 0.18 to 2.12 mg F/d. The 33 subjects living in a DWF region showed a mean urine fluoride concentration of 0.64 +/- 0.24 ppm (mg/l) and a mean fluoride excretion of 1.14 +/- 0.48 mg F/d. Those 36 subjects living in a region without DWF showed a mean urine fluoride concentration of 0.47 +/- 0.24 ppm (mg/l) and a mean fluoride excretion of 0.78 +/- 0.40 mg F/d. A significant difference between the two means of the groups living in regions with or without DWF was detected when the Mann-Whitney statistical test was applied (p < 0.005). The combined intake of fluoridated drinking water and fluoridated table salt in the sub-group of 11 subjects who commuted showed an overall increase in fluoride urine concentration. The measured values, however, were not significantly different from the other sub-groups.
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Fluoruración , Fluoruros/orina , Cloruro de Sodio Dietético , Fluoruro de Sodio , Adulto , Creatinina/orina , Femenino , Humanos , Electrodos de Iones Selectos , Masculino , Antisépticos Bucales , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Suiza , Cepillado DentalRESUMEN
A purely retroperitoneoscopic approach in living kidney donation is used by only a few centers worldwide. Data from 28 consecutive purely retroperitoneoscopic living donor nephrectomies (RLDN) were compared to the most recent 30 open living donor nephrectomies (OLDN). Right-sided donation was performed in 12 cases (43%) of the RLDN and 11 cases (37%) of the OLDN. Comparison of the results between the two groups showed a shorter operation time and hospital stay for the RLDN group (P < 0.001). Warm ischemia time was significantly shorter in the OLDN group (P < 0.02). The rate of complications did not differ significantly between the groups. No significant difference in terms of renal graft function was detected within 30 days after surgery. As a result of the direct access, RLDN is superior in terms of operation time, even to the open access on our series, while maintaining the advantage of minimal invasiveness.
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Trasplante de Riñón , Donadores Vivos , Nefrectomía/métodos , Adolescente , Adulto , Humanos , Laparoscopios , Espacio Retroperitoneal/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The wish for a minimally invasive procedure is one of the utmost demands by all persons undergoing living-donor nephrectomies. The retroperitoneoscopic access for this procedure has proven to be a safe, minimally invasive, and efficient approach accompanied by early mobilization and a fast return to general daily activities. The incidence of complications during and after this technically demanding operation is comparable to that of other approaches. Because of the direct anatomic approach, retroperitoneoscopic living-donor nephrectomy has become the preferred access at our institution for both donors and surgeons.
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Trasplante de Riñón/métodos , Laparoscopía/métodos , Donadores Vivos , Nefrectomía/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Espacio Retroperitoneal , Resultado del TratamientoRESUMEN
The purpose of this qualitative study was to explore the responses and experiences of a sample of Swiss men after radical prostatectomy and their intimate partners. Interviews were conducted with 10 couples and analyzed using constant comparative method. Getting a grip on it was the core process that was developed. Men focused on regaining control over their lives, urinary and erectile function while wives efforts focused on being there. The results revealed that current clinical practice of follow up at 3 months may not address the serious deficits in the patient's ability to "get a grip" on incontinence and other complications of surgery.
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Actitud Frente a la Salud , Hombres/psicología , Prostatectomía/psicología , Esposos/psicología , Actividades Cotidianas , Adaptación Psicológica , Convalecencia/psicología , Estudios Transversales , Disfunción Eréctil/etiología , Disfunción Eréctil/prevención & control , Femenino , Humanos , Control Interno-Externo , Masculino , Matrimonio/psicología , Persona de Mediana Edad , Investigación Metodológica en Enfermería , Prostatectomía/efectos adversos , Prostatectomía/métodos , Investigación Cualitativa , Calidad de Vida , Recuperación de la Función , Encuestas y Cuestionarios , Suiza , Incontinencia Urinaria/etiología , Incontinencia Urinaria/prevención & controlRESUMEN
Currently, no consensus exists on the best method for tumor quantification in prostate cancer (PCA), and its prognostic value remains controversial. We evaluated how a newly defined maximum tumor diameter (MTD) might contribute to the prediction of biochemical recurrence (BCR) in a consecutive series of PCA patients treated with radical prostatectomy (RP). Patients with PCA who underwent RP without neoadjuvant therapy at a single center were included for analysis. MTD was defined as the largest diameter of all identified tumors in all three dimensions (i.e., length, width, or depth) of the prostate ("Basel technique"). Cox regression models addressed the association of MTD with BCR in three risk groups (low risk-prostate-specific antigen (PSA) < 10 ng/ml, pT2, and Gleason score (GS) ≤ 6; intermediate risk-PSA ≥ 10 and <20 ng/ml and/or pT2 and GS = 7; high risk-PSA > 20 ng/ml or pT3 or GS ≥ 8) and whole cohort. Within a median follow-up of 44 months (interquartile range (IQR) 23-66), 48 patients (9.4 %) in the intermediate-risk and high-risk groups experienced BCR. In multivariate Cox regression analysis, PSA, pathological stage (pT stage), GS, positive surgical margins (PSMs), and MTD > 19.5 mm were independent predictors for BCR (p < 0.05). In subgroup analysis, MTD as a nominal variable (<24.5 and >24.5 mm) was the only independent predictor of BCR in the intermediate-risk group (hazard ratio (HR) 9.933, 95 % confidence interval (CI) 2.070-47.665; p < 0.05). MTD is an independent risk factor of BCR in PC patients after RP. The combination of the MTD with other well-known prognostic factors after RP may improve decision-making concerning follow-up intensity or adjuvant treatment.
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Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias/métodos , Neoplasias de la Próstata/patología , Anciano , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Prostatectomía , Neoplasias de la Próstata/cirugía , Curva ROC , Factores de RiesgoRESUMEN
OBJECTIVE: To compare the performance of the Epstein criteria and the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria in the identification of patients eligible for active surveillance (AS) but treated with radical prostatectomy. MATERIALS AND METHODS: We evaluated the baseline characteristics, final pathologic examination, and prostate-specific antigen follow-up (median 43 months, range 1-118) in a series of 492 consecutive patients with prostate cancer managed by radical prostatectomy without AS from 2001 to 2011 at a single institution. Using the postoperative histologic findings, multivariate analysis was used to identify the preoperative predictors of unfavorable AS selection (Gleason score >6 and/or greater than stage pT2c on the final pathologic examination). Biochemical recurrence-free survival was compared between favorably and unfavorably selected patients. RESULTS: Applying the Epstein and PRIAS criteria, 29.2% and 32.2% of the patients had Gleason score >6 or stage pT3 on final pathologic examination, respectively. After a median follow-up of 35.5 and 38 months, 4.2% and 4.3% of patients developed biochemical recurrence in the Epstein and PRIAS criteria groups, respectively. Patients with unfavorable selection had significantly worse biochemical recurrence-free survival than patients with favorable selection (P <.05). Although the median biopsy core number was 8, a biopsy core number <9 was a significant and independent predictor for unfavorable preoperative AS selection in the PRIAS group. CONCLUSION: We found a non-negligible risk of underestimating unfavorable cancer in patients theoretically qualifying for AS in our cohort. The current use of a sufficient number of biopsy cores might improve the selection process for AS.