[Serum cellular inflammatory markers in the diagnosis of prostate cancer.] / Marcadores inflamatorios celulares séricos en el diagnóstico de cáncer de próstata.

Prostate cancer (PCa) is one of the most frequent neoplasms in the masculine sex, which has multiple etiological factors, inflammation is one of them. OBJECTIVE: To determine the role of different inflammatory markers in the diagnosis of PCa in first prostatic biopsies. METHODS: This is a prospective study evaluating neutrophil/ lymphocyte (NLR), neutrophil/monocyte (NMR) and platelet/lymphocyte (PLR) ratios of 78 patients with suspected PCa due to PSA alteration and/or abnormal digital rectal examination, and its correlation with twelve-cylinder biopsy result. RESULTS: The NLR, NMR and PLR were all higher in the group diagnosed with PCa compared to the group with benign prostatic hyperplasia (p > 0.05). CONCLUSIONS: Inflammatory markers can be predictive factors in the diagnosis of PCa, although more studies are needed for their routine use.

El cáncer de próstata (CaP) es una de las neoplasias más frecuentes en el sexo masculino, la cual tiene descrito múltiples factores etiológicos, entre ellos la inflamación. OBJETIVO: Describir el papel de diferentes marcadores inflamatorios en el diagnóstico de CaP en biopsias prostáticas por primera vez.MÉTODOS: Es un estudio prospectivo donde se evaluaron las relaciones neutrófilo/linfocito (RNL), neutrófilo/ monocito (RNM) y plaqueta/linfocito (RPL) séricas de 78 pacientes con sospecha de CaP por alteración de PSA y/o tacto rectal, y su correlación con el resultado de biopsia de 12 cilindros. RESULTADOS: Las RNL, RNM y RPL fueron todas más elevadas en el grupo con diagnóstico de CaP en comparación al grupo con hiperplasia prostática benigna (p > 0,05). CONCLUSIONES: Los marcadores inflamatorios pueden ser factores predictivos en el diagnóstico de CaP, que necesitan más estudios para su utilización rutinaria.

Oxalobacter formigenes: Opening the door to probiotic therapy for the treatment of hyperoxaluria.

OBJECTIVE: The aim of this study was to determine the early effect of the administration of Oxalobacter formigenes on the metabolic pattern of patients with calcium oxalate stones, comparing it with potassium magnesium citrate (KMgCit). MATERIALS AND METHODS: Eighty patients were randomized to receive either 30 mEq of KMgCit or 700 million O. formigenes, both twice a day. Serum creatinine, serum urate, serum calcium and phosphorus, serum intact parathyroid hormone (if serum calcium >10.5 mg/dl) and 24 h urine metabolic evaluation for various metabolites (e.g. oxalate, calcium, phosphorus, citrate, magnesium, urate and creatinine) were evaluated at baseline and 1 month after starting the treatment. RESULTS: In both groups hyperoxaluria was the most common abnormality, followed by hypercalciuria. The incidence of hyperoxaluria decreased at 1 month compared to baseline in both KMgCit (77.5% vs 37.5%, p = 0.0006) and O. formigenes preparation (82.5% vs 15%, p < 0.0001) groups, while other urinary metabolic abnormalities were similar at baseline and 1 month in both groups. Three patients in the KMgCit had mild self-limiting secondary symptoms. CONCLUSION: Compared with KMgCit, O. formigenes preparation is more effective in decreasing the incidence of hyperoxaluria, opening the door to probiotic therapy as a potential new weapon against hyperoxaluria.

Percutaneous nephrolithotomy in pelvic kidneys: is the ultrasound-guided puncture safe?

OBJECTIVE: To demonstrate our experience with the use of ultrasound (USG) for puncture guidance while performing percutaneous nephrolithotomy in ectopic pelvic kidneys. METHODS: From January 1990 to December 2013, we have performed percutaneous nephrolithotomy in 26 patients with USG-guided punctures. The stones were solitary in 15 patients (58%) and multiple in 11 patients (42%). The mean stone size was 22 mm (range, 10-50 mm), including 3 staghorn calculi. All procedures were performed in an oblique-supine position, and the intraoperative complications as the postoperative outcome were reviewed. RESULTS: The mean operative time was 93 minutes, achieving complete stone clearance in 22 (88%) of the patients. One of the patients had urine leakage after removing nephrostomy, needing postoperative double J stenting. One patient had significant intraoperative bleeding requiring staging of the procedure and blood transfusion. No bowel injuries were identified. Mean hospitalization time was 5.6 days. CONCLUSION: USG-guided puncture is a safe and effective approach to the collecting system even in renal anomalies like in pelvic ectopic kidneys when performed in experienced hands.

Laparoscopic common bile duct exploration four-task training model: construct validity.

BACKGROUND: Training models in laparoscopic surgery allow the surgical team to practice procedures in a safe environment. We have proposed the use of a 4-task, low-cost inert model to practice critical steps of laparoscopic common bile duct exploration. METHODS: The performance of 3 groups with different levels of expertise in laparoscopic surgery, novices (A), intermediates (B), and experts (C), was evaluated using a low-cost inert model in the following tasks: (1) intraoperative cholangiography catheter insertion, (2) transcystic exploration, (3) T-tube placement, and (4) choledochoscope management. Kruskal-Wallis and Mann-Whitney tests were used to identify differences among the groups. RESULTS: A total of 14 individuals were evaluated: 5 novices (A), 5 intermediates (B), and 4 experts (C). The results involving intraoperative cholangiography catheter insertion were similar among the 3 groups. As for the other tasks, the expert had better results than the other 2, in which no significant differences occurred. The proposed model is able to discriminate among individuals with different levels of expertise, indicating that the abilities that the model evaluates are relevant in the surgeon's performance in CBD exploration. CONCLUSIONS: Construct validity for tasks 2 and 3 was demonstrated. However, task 1 was no capable of distinguishing between groups, and task 4 was not statistically validated.

Uso del laser holmium para el manejo de coledocolitiasis compleja en la exploración laparoscópica de las vías biliares / Use of holmium laser for management of complex choledocholithiasis in laparoscopic bile duct exploration

Presentar la primera experiencia nacional con el uso de Holmium Láser en la exploración laparoscópica de las vías biliares para el manejo de cálculos en la vía biliar intrahepática, llevado a acabo en el Hospital Universitario de Caracas, en el Servicio de Cirugía III. Se presenta caso de paciente femenina de 35 años de edad, con clínica de síndrome ictérico obstrutivo, a quien se le realizó colangiopancreatografía retrógrada endoscópica evidenciando cálculos impactados en la vía biliar izquierda, sin lograr la extracción de los mismos, motivo por el cual se decide realizar exploración laparoscópica la vía biliar con el uso del Holmium laser para la litotripsia. Se realizó exploración laparoscópica de las vías biliares y litotripsia con Holmium Laser, logrando la fragmentación y extracción de los mismos. La paciente evolucionó de forma satisfactoria, sin complicaciones, siendo egresada al tercer día de postoperatorio. Cuando la colangiopancreatografía retrograda endoscopica resulta ineficiente en el caso de cálculos intrahepáticos o cálculos grandes impactados en la vía biliar, el siguiente paso es la exploración qurúrgica. La exploración laparoscópica con el uso de Holmium Laser permite la listotripsia a través de ablación fototérmica sin riesgo de lesionar estructuras adyacentes, obteniendo resultados favorables y aumentando la tasa de efectividad del procedimiento cuando se trata de coledocolitiasis compleja.

Present the first national experience with the use of Holmium Laser in laparoscopic common bile duct exploration for the management of intrahepatic bile duct stones, performed in Surgery Department III at the Hospital Universitario de Caracas. A 35 years old female with obstructive jaundice syndrome who underwent endoscopic retrograde cholangiopancreatography showing impacted stones in the left hepatic duct. Being impossible to clear the stones, a laparoscopic common bile duct exploration with the Holmium Laser was performed. A laparoscopic common bile duct exploration and Holmium Laser was performed, achieving stone clearance. The patient was dischanged with no complication on the third postoperatory day. When endoscopic retrogarade cholangiopancreatography is inefficient in the case of intrahepatic stones or large stones impacted in the common bile, the mext step is surgical exploration. Laparoscopic common bile duct exploration with the Holmium Laser result in photothermal of stones without injury to surrounding structures, obtaining favorable results and increasing the rate of effectiveness of the procedure in the management of complex billary tract caluli.

Exploración laparoscopica de la vía biliar: validación de un modelo de entrenamiento / Laparoscopic exploration of the bile duct: validation of a training model

Para determinar la capacidad de las evaluaciones realizadas con un modelo de entrenamiento para diferenciar el desempeño entre individuos con diferentes niveles de experiencia, se realizó un estudio en 14 individuos distribuidos en tres grupos con distinto nivel de entrenamiento en cirugía laparoscópica: 5 novatos (A), 5 intermedios (B) y 4 expertos (C), en las tareas colangiografía intraoperatoria, exploración transcística, colocación del tubo de Kehr y coledocoscopia. Se emplearon las pruebas de Kruskal-Wallis y Mann-Whitney para detectar diferencias entre los grupos. Los resultados de la evaluación de la tarea colangiografía intraoperatoria fueron semejantes para todos los grupos. En las otras estaciones el grupo de expertos resultó superior a los otros dos, que no mostraron entre sí diferencias relevantes. Observamos que el modelo es capaz de discriminar entre sujetos que poseen diferente nivel de experiencia en este procedimiento, lo que indica que las habilidades que el mismo evalúa son relevantes en el desempeño del cirujano en la ELVB. El modelo evaluado permite diferenciar entre cirujanos que poseen experiencia en cirugía laparoscopica de vía biliar principal y aquellos que no la tienen, por lo que recomendamos que los individuos en formación lo empleen como herramienta de entrenamiento y evaluación.

To determine the success of the proposed model to distinguish the performance of individuals with different levels of experience, three groups based on their surgery level experience was evaluated: 5 novice (A), 5 intermediate (B), and 4 expert (C) in the tasks of: intraoperative cholangiography, transcystic exploration, t-tube introduction and choledocoscope. Both tests, the Kruskal-Wallis one-way analysis of variance and the Mann-Whitney significance test, were employed to detect skills differences between the groups. The results of the evaluation on the task for intraoperative cholangiography were similar for all the groups. Yet, on the other tasks the group of experts turned out to be superior to the other two groups, which did not show significant differences between them. We observe that such model is capable of recognizing variations between subjects that possess different level of experience in this procedure, which indicates that the skills that this model evaluates are relevant in the performance of the surgeon in the LCBDE. The evaluated model allows one to differentiate between those subjects who have experience in laparoscopic biliary tract surgery and those that do not have it. It is recommended that those individuals currently schooling should use it as a training and evaluation tool.