Influence of instrumentation on the surgical time to implant a total knee prosthesis. / Influencia de la instrumentación sobre el tiempo quirúrgico para implantar una prótesis total de rodilla.

OBJECTIVE: To demonstrate if there is a difference in the time that the surgery is prolonged to implant a knee prosthesis according to the instrumentation system used. MATERIAL AND METHODS: Retrospective analysis of the duration of 243 interventions (skin-to-skin time and ischemia time) performed by the same surgeon. Seventy-two cases operated with conventional instruments (IC), 68 by means of computer assisted surgery (CAS) and 103 with personalized instrumentation system (PSI). RESULTS: IC skin-to-skin time 87,85 min (SD 11,86). IC ischemia time 94,44 min (SD 11,49). Computer assisted surgery skin-to-skin time 123,46 min (SD 11,27). Computer assisted surgery ischemia time 129,63 min (SD 11,37). PSI skin-to-skin time 78,69 min (SD 13,06). PSI ischemia time 84,63 min (SD 12,06). There is a significant difference between PSI and the other instrumentation systems (p 0,000). CONCLUSIONS: In our study, the time consumption for the implantation of a knee prosthesis has been significantly lower when cutting blocks have been used, than when we have used other systems.

Monitoring of glycolytic activity secondary to ischaemia in knee replacement surgery. / Monitorización de la actividad glucolítica secundaria a isquemia en cirugía sustitutiva de rodilla.

OBJECTIVES: To non-invasively assess tissue lesion secondary to ischaemia applied during knee replacement surgery. Secondary objectives: to assess whether this lesion correlates with the duration of ischaemia and whether instrumental and gender variables influence it. MATERIAL AND METHODS: Prospective cohort study. Pre and postoperative serum lactate levels have been determined as an indicator of glycolytic activity secondary to ischaemia in 88 patients. Serum lactate determination was performed by reactive strips of enzymatic-amperometric detection on capillary blood. RESULTS: Preoperative serum lactate levels (mean and SD): 2.467±1.036 mmol/L. Postoperative serum lactate levels: 3.938±2.018 mmol/L. Ischaemia time 102.98±18.25minutes. Postoperative serum lactate levels were significantly higher than preoperative lactate levels. There are no statistical differences according to the time that the ischaemia was prolonged, gender or type of instrumentation used. CONCLUSIONS: In our study, postoperative serum lactate values were significantly higher than preoperative lactate values, with no correlation to the duration of ischaemia during knee replacement surgery.

Analysis of uni and bi-parental markers in mixture samples: Lessons from the 22nd GHEP-ISFG Intercomparison Exercise.

Since 1992, the Spanish and Portuguese-Speaking Working Group of the ISFG (GHEP-ISFG) has been organizing annual Intercomparison Exercises (IEs) coordinated by the Quality Service at the National Institute of Toxicology and Forensic Sciences (INTCF) from Madrid, aiming to provide proficiency tests for forensic DNA laboratories. Each annual exercise comprises a Basic (recently accredited under ISO/IEC 17043: 2010) and an Advanced Level, both including a kinship and a forensic module. Here, we show the results for both autosomal and sex-chromosomal STRs, and for mitochondrial DNA (mtDNA) in two samples included in the forensic modules, namely a mixture 2:1 (v/v) saliva/blood (M4) and a mixture 4:1 (v/v) saliva/semen (M8) out of the five items provided in the 2014 GHEP-ISFG IE. Discrepancies, other than typos or nomenclature errors (over the total allele calls), represented 6.5% (M4) and 4.7% (M8) for autosomal STRs, 15.4% (M4) and 7.8% (M8) for X-STRs, and 1.2% (M4) and 0.0% (M8) for Y-STRs. Drop-out and drop-in alleles were the main cause of errors, with laboratories using different criteria regarding inclusion of minor peaks and stutter bands. Commonly used commercial kits yielded different results for a micro-variant detected at locus D12S391. In addition, the analysis of electropherograms revealed that the proportions of the contributors detected in the mixtures varied among the participants. In regards to mtDNA analysis, besides important discrepancies in reporting heteroplasmies, there was no agreement for the results of sample M4. Thus, while some laboratories documented a single control region haplotype, a few reported unexpected profiles (suggesting contamination problems). For M8, most laboratories detected only the haplotype corresponding to the saliva. Although the GHEP-ISFG has already a large experience in IEs, the present multi-centric study revealed challenges that still exist related to DNA mixtures interpretation. Overall, the results emphasize the need for further research and training actions in order to improve the analysis of mixtures among the forensic practitioners.

[Update in pudendal nerve entrapment syndrome: an approach anatomic-surgical, diagnostic and therapeutic]. / Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico, diagnóstico y terapéutico.

INTRODUCTION: The syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area. OBJECTIVES: To make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment. MATERIAL AND METHODS: We performed a literature search through the database Pubmed using the terms Pudendal nerve, Pudendal nerve entrapment syndrome, Pelvic floor neuropathic pain, Pelvic floor myofascial syndrome, Pudendal nerve decompression. Also, selected works in English, Spanish and French, also reviewing the articles relate this work. RESULTS: We develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery. CONCLUSION: It is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

[Myofascial pain syndrome in the pelvic floor: a common urological condition]. / Síndrome de dolor miofascial del suelo pélvico: una patología urológica muy frecuente.

INTRODUCTION: Myofascial pain syndrome in the pelvic floor is a very common condition in the urological field and is often ignored or misdiagnosed. OBJECTIVES: To present the prevalence of this syndrome to professionals of urology through a systematic review of existing literature and its potentials for diagnosis and treatment. MATERIALS AND METHODS: We performed a literature search through the database "Pubmed" using the terms "Trigger points", "myofascial pain", "referred pain", "infiltrations" and "physical therapy", to which we add the term "pelvic floor". Then, we select the works in English, Spanish and French that we might like. RESULTS: We develop the highlights of the syndrome: anatomy, etiology, anatomical-clinical correlation, epidemiology, perpetuating factors, diagnosis, medical therapy and physiotherapy treatment. CONCLUSION: It is the most common cause of pain in the pelvic floor and greatly affects quality of life of patients. Nowadays, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

[Technical and economic reasons to set up robotic surgery in a public health system (Spanish model)]. / Razones técnicas y económicas para la implantación de la Cirugía Robótica en un Sistema Público de Salud (modelo Español).

Radical prostatectomy (RP) is today, in any of its four approaches (perineal (PRP), retropubic (ARP), laparoscopic (LRP) or robotic (RRP), the standard surgical treatment in localized prostate cancer. It looks clear that the minimum invasive approaches (laparoscopy and robotics) are able to reduce hospital stay as well as blood loss and therefore transfusion requirement. Also, laparoscopic results at mid and robotics at short term, seem to indicate, that both are safe oncologically and able to obtain same or even superior, functional results. Our objective has been to evaluate the economic impact that these techniques have to consider their definitive implantation, as well as the advantages and disadvantages of its potential implementation in our health system.

[Radical prostatectomy: open, laparoscopic and robotic. Looking for a new gold standard?]. / Prostatectomia radical abierta, laparoscópica y robótica: En busca de un nuevo gold standard?

INTRODUCTION: It is well known that radical prostatectomy (RP) is an excellent option in localized prostatic cancer especially from oncological control point of view. The efforts, during last decades, of the urological community in this field have been addressed in trying to improve functional outcomes (urinary and sexual morbidity) after the procedure. From the beginning of this century, three managements (open, robotic and laparoscopic) have been coexisting trying to get and prove the best results. The objective of this review has been to make the most exhaustive, rigorous and objective updating with the functional and oncological outcomes from the three (RP) techniques. MATERIAL AND METHODS: We have centered the comparison in four sections: perioperative, oncological outcomes, functional results and economic costs. With this purpose a systematic search was made in the following registers: PubMed, OVID, EMBASE and Cochrane Library, with the following terms: Retropubic RP. open RP, laparoscopic RP, robotic RP, Sexual function, urinary incontinence, quality of life, economic costs. At author's criteria, a total of 73 references were selected, that were individually analyzed. RESULTS: Whatever the technique is, the mortality related to the procedure is extremely low, with little postoperative pain and minimum analgesic requirements. The oncological results are similar, measured in surgical margin terms: Open RP (14-20%), Laparoscopic RP (7.4-21.9%) and robotic RP (5.7-17.3%). Concerning functional results (sexual function and urinary continence), it is difficult to establish comparisons due to the multitude of existing byas (non randomized studies, different methods and measurement scales, different definitions, etc.) In the uni-insitutional studies, results seem to be equivalent. CONCLUSIONS: Laparoscopic and robotic RP series are still pending of mature outcomes, related to long term biochemical control and functional results. It seems that with these managements, blood loss and transfusion needs are minor compared to open surgery. Robotic technology adds very interesting advantages that could have an important role in homogenize the minimally invasive management, but are still pending of validation at medium and long term.

[Infection for papillomavirus in the man. Current state]. / Infección por papillomavirus en el hombre. Estado actual.

The Virus of the Human Papiloma (HPV), classically he/she has been related with infections of sexual transmission and processes wicked oncologists of the feminine genital apparatus and with less frequency of the masculine one. The new technical diagnostics, based on molecular biology (by means of polymerase chain reaction), they help to a better epidemic approach, an improvement in the I diagnose viral, and a correct therapeutic focus. The object of this work is to revise the current state of the HPV from the points of view etiopathogenics, epidemic, clinical, diagnosis, therapeutic and preservative.

[Symptomatic leiomyoma of the kidney: renal mass with difficult preoperative diagnosis]. / Leiomioma renal sintomático: una masa renal de difícil diagnóstico.

Renal leiomyoma is a benign mesenchymal tumour that, albeit very rare, has to be ruled out when a renal mass has been diagnosed. This tumour can arise from any organ of the genitourinary tract with smooth muscle cells, being the renal capsule the most frequent origin. As its behaviour is not aggressive, nephron-sparing surgery is indicated. However, as it is difficult to preoperatively differentiate the leiomyoma from the adenocarcinoma, the former is commonly diagnosed after examination of the entire organ surgically removed.

[Urinary fistula: update]. / Fístulas urinarias: puesta al día.

The urinary fistulas are not a frequent problem in our urological rutinary work, being the vesicovaginal ones the most common. However, it will be necessary to know them to be able to diagnose and treat them in the best way. In this article we classificate the different urinary fistulas (uro-gynecologicals, uro-vasculars, uro-cutaneous and entero-urinarys), explaining the possible etiologies and the correct management.

[Reabsorption syndrome after transurethral resection (TUR) of the prostate: review of physiologic, diagnostic, and therapeutic features]. / Síndrome de reabsorción post-resección transuretral (R.T.U.) de próstata: revisión de aspectos fisiopatológicos, diagnósticos y terapéuticos.

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as "Transurethral prostatic resection syndrome" or "TURP syndrome". The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.

Cloning and expression of two genes coding for sodium pumps in the salt-tolerant yeast Debaryomyces hansenii.

Two genes encoding Na(+)-ATPases from Debaryomyces hansenii were cloned and sequenced. The genes, designated ENA1 from D. hansenii (DhENA1) and DhENA2, exhibited high homology with the corresponding genes from Schwanniomyces occidentalis. DhENA1 was expressed in the presence of high Na(+) concentrations, while the expression of DhENA2 also required high pH. A mutant of Saccharomyces cerevisiae lacking the Na(+) efflux systems and sensitive to Na(+), when transformed with DhENA1 or DhENA2, recovered Na(+) tolerance and also the ability to extrude Na(+).

[Solitary renal metastasis of primary esophageal cancer]. / Metástasis renal solitaria de un cáncer primario esofágico.

We present an unusual case of single kidney metastasis from an primary esophageal neoplasm. Its main clinical and diagnostic topics are described. They made us consider him as a good candidate for surgery. The pathological study of the nephrectomy specimen was surprising. The postoperative period was unfortunate, however.

Effects of salts on Debaryomyces hansenii and Saccharomyces cerevisiae under stress conditions.

The effect of Na+ and K+ on growth and thermal death of Debaryomyces hansenii and Saccharomyces cerevisiae were compared under stress conditions as those commonly found in food environments. At the supraoptimal temperature of 34 degrees C both cations at concentrations of 0.5 M stimulated growth of D. hansenii, while K+ had no effect and Na+ inhibited growth of S. cerevisiae. At 8 degrees C, close to the minimum temperature for growth in both species, both cations inhibited both yeasts, this effect being more pronounced with Na+ in S. cerevisiae. At extreme pH values (7.8 and 3.5) both cations at concentrations of 0.25 M stimulated D. hansenii while Na+ inhibited S. cerevisiae. K+ inhibited this yeast at pH 3.5. Thermal inactivation rates, measured at 38 degrees C in D. hansenii and at 48 degrees C in S. cerevisiae, decreased in the presence of both cations. This protective effect could be observed in a wider range of concentrations in D. hansenii. These results call the attention to the fact that not all yeasts have the same behaviour on what concerns synergy or antagonism of salt together with other stress factors and should be taken into consideration in the establishment of food preservation procedures.

[Lymphadenectomy in squamous carcinoma of the penis: review of our series]. / Linfadenectomía en el carcinoma escamoso de pene: revisión de nuestra serie.

OBJECTIVE: To analyze the series of patients who underwent inguinal lymphadenectomy in our Center due to squamous penile carcinoma, between years 1984 to 1999. MATERIAL AND METHODS: Lymphadenectomy was carried out in 19 patients, with a mean age of 61 years. Bilateral ilioinguinal (42.1%) was the most frequent type of intervention. Only four patients underwent penectomy and lymphadenectomy simultaneously. We present the clinical and pathological results, according to the 1997 TNM classification. RESULTS: Palpable inguinal nodes after antibiotherapy remained in seven out of 12 patients. The overall correlation between N and pN stages in our series was 68.42%. Pathological results according to pT and pN stages are also presented. Postoperative complications were present in 13 cases (68.42%), (lymphedema being the most frequent one). In those patients with two or less pN(+) nodes, an overall one-year and five-year survival of 90 and 80% were obtained; compared to 11.11 and 0% when there were more than two. CONCLUSIONS: The importance about control of metastatic lymph nodes in squamous carcinoma of the penis, places inguinal lymphadenectomy as an essential tool, in those suitable cases. However, its incidence of complications makes a progressive agreement about its indications be necessary.

[Replacement of prosthesis of the penis]. / Sustitución de prótesis de pene: 1990-1999.

OBJECTIVE: To analyze the series of patients who underwent replacement of their penile prosthesis between years 1990 to 1999, due to any kind of complication. MATERIAL AND METHODS: 85 patients underwent implantation, 13 different prosthesis models being utilized. It was replaced (once or more) in 15 of these patients (17.64%). The mean age at the moment of the replacement was 51.5 years. The most frequent surgical approach was the infrapubic one. RESULTS: A total of 32 prosthesis-replacement interventions were carried out. The main causes were: mechanical failure (13 cases, 40.62%); infection (10 cases, 31.25%); and corpus cavernosum perforation (five cases, 15.62%). Progressive increase of complications incidence with regard to the ordinal number of the implanted prosthesis was not observed. Best overall results: Mentor Mark II and AMS 700 Ultrex Plus. At present day, only eight (53.33%) out of 15 reimplanted patients use their prosthesis with normality. CONCLUSIONS: Those patients who undergo replacement of their penile prosthesis are potential sources for later complications. Their knowledge and proper handling is important in order to a progressive improvement of the final results, (above all if--such as our case--these ones are not suitable for conformity).