Ahmed glaucoma drainage implant surgery in the management of refractory uveitic glaucoma: Long-term follow up. / Implante de válvula de Ahmed para el manejo del glaucoma uveítico refractario: seguimiento a largo plazo.

OBJECTIVE: To examine the long-term efficacy, safety and complications of Ahmed glaucoma drainage implant surgery in patients with refractory uveitic glaucoma. METHODS: Retrospective review of consecutive cases of patients with refractory uveitic glaucoma who underwent Ahmed glaucoma drainage implant surgery between 2004-2014. Demographic characteristics of the study population, visual acuity, intraocular pressure (IOP), number of antiglaucoma medications and operative and postoperative complications were recorded. Complete success was defined as IOP≥5 and ≤18mmHg without any medication, as qualified success if IOP≤18mmHg with one or more medications. Patients with less than 12 months of follow-up were excluded. RESULTS: 21 patients (26 eyes) were included. The mean postoperative follow-up was 53.5±31 months. Eight eyes (30%) had at least one previously failed glaucoma surgery. IOP was reduced from a mean of 30.0mmHg to 14.0mmHg at the last follow-up visit (P<.001). The number of IOP-lowering medications was reduced from a median of 2.9 preoperatively to 1.1 at the last follow-up (P<.001). Overall, 7 eyes (27%) were classified as complete success, 13 eyes (50%) were considered as qualified success, and 6 eyes (23%) met the criteria for failure. The most common postoperative complication was hypertensive phase in 12 eyes (46%). Kaplan-Meier life-table analysis showed a cumulative probability of success after Ahmed glaucoma valve implantation of 65% at 84 months. CONCLUSIONS: Ahmed glaucoma drainage implant surgery may be considered a long-term effective and safety surgical option for patients with refractory uveitic glaucoma.

[Integral incident management system in primary care: Beyond patient safety]. / Sistema integral de gestión de incidencias en atención primaria: más allá de la seguridad del paciente.

OBJECTIVE: To describe an integral system of notification and management of incidents, created by the Primary Care Team of Guineueta, as well as the main results after 18 months of implementation. MATERIAL AND METHOD: Using a simple online form, health professionals notified any type of, already categorised, incident. Each of them were distributed to an improvement team that assessed and performed the necessary actions. In addition, the Quality Committee immediately assessed the ones that affected patient safety, as well as the most relevant or repetitive ones every 6 months. RESULTS: During the first 18 months of operation of the system, the health professionals reported 1,267 incidents, most notably informatics, maintenance/technical assistance, and errors in scheduling, in internal circuits and protocols. Eight of them were considered to significantly affect patient safety. CONCLUSIONS: The implementation of the described system has been consolidated into our team, facilitating the detection of problems, the accomplishment of improvement actions and involving the professionals in the improvement of the quality.

[Analysis of the Doppler signal (color and pulsed) in hepatocarcinoma]. / Análisis de la señal Doppler (color y pulsado) en el hepatocarcinoma.

Real time echocardiography associated with pulsed Doppler (duplex) and color (triplex) provide a non invasive technique to determine the vascular morphology of a lesion. The duplex and triplex signal of 35 liver tumors, 23 hepatocarcinomas and 12 angiomas found in the first high frequency signals greater than 1.81 kHz and traced with pulsatile or mixed morphology (pulsed and continuous) were analyzed. The second signals were of low frequency, less than 1 kHz and continuous tracing. It may be concluded than echo-Doppler is a complementary technique to conventional echography and is useful in the diagnosis of hepatocellular carcinoma.

Magnetic resonance imaging of the intrauterine fetal genitourinary tract: normal anatomy and pathology.

Although ultrasonography (US) remains the most widely used diagnostic imaging modality for routine evaluation of the fetus, magnetic resonance (MR) imaging has become an invaluable complement to US in all cases in which additional information is desirable. While the ability of US to detect fetal abnormalities is limited in cases such as maternal obesity, oligohydramnios, and in certain fetal positions, MR using fast and ultrafast pulse sequences enables high-quality fetal images to be acquired regardless of the mother's physical condition or fetal position. Fetal genitourinary disorders are the most common intrauterine abnormalities detected by US, accounting for approximately 30% of all antenatally detected anomalies. Although they usually occur in isolation, these defects can form part of more complex syndromes or chromosomopathies, and MR is indicated to rule out associated abnormalities. In some severe genitourinary disorders, there is a severe deficit of amniotic fluid; these cases are associated with other fetal anomalies such as pulmonary hypoplasia and very poor prognosis. In other cases, the amniotic fluid is not compromised, yet the further detection, localization, and characterization of prenatal disorders will have an impact on postnatal follow-up. This article reviews the role of fetal MR in urogenital tract disorders.

Importance of the active component of the detrusor muscle in bladder compliance.

An appropriate experimental study was designed and carried out in mongrel dogs, in order to evaluate the active muscle and cholinergic participation on bladder compliance. The filling bladder pressure was measured at 100 ml of bladder volume, in 50 dogs distributed into five groups of 10 dogs each: (1) control group, (2) group which received atropine (cholinergic antagonist), (3) group which received verapamil (extracellular Ca2+ blocker), (4) group which received nitroprusside (intracellular Ca2+ antagonist), and (5) group which received EGTA (Ca(2+)-chelating agent). Furthermore, the following was demonstrated. (1) The greatest decrease of the bladder filling pressure was observed in the group which was treated with EGTA. (2) A significant decrease of the bladder filling pressure was also seen in the group which was given nitroprusside. (3) The decrease of bladder filling pressure in the verapamil group tended towards statistical significance. (4) There was no decrease in the atropine group. Thus, it was concluded that the active muscle component has an important role in the bladder compliance (through the intracellular calcium fraction), and the cholinergic component does not participate in the bladder compliance.

A study on the viscoelastic properties of the urinary bladder in dogs.

This experimental study was designed and carried out in order to investigate the participation of the collagen and muscular tissues on the viscoelastic properties of the bladder wall. Sixty-five adult male mongrel dogs were utilized. These animals were divided into 5 groups: control group (n = 10); dogs (n = 10) receiving 2.5 mg/kg atropine (cholinergic antagonist); dogs (n = 10) receiving 0.7 mg/kg verapamil (calcium extracellular inflow blocker); dogs (n = 10) receiving 0.1 mg/kg/min nitroprusside (intracellular calcium blocker), and dogs (n = 25) receiving EGTA (a calcium-chelating agent) at increasing doses from 90 to 450 mg/kg. Based on a mathematical model, we have demonstrated that: (1) the collagen component is responsible for the elastic properties; (2) the muscle component is responsible for the viscoelastic properties; (3) the viscoelastic properties have an active element which is affected by calcium total depletion, and (4) such viscoelastic properties are not dependent on cholinergic stimulation.

Fetal and placenta chromosome constitution in 237 pregnancy losses.

The aim of the study was to carry out cytogenetic analyses in pregnancy losses. Samples of cartilage and placenta tissue were obtained prospectively from 237 pregnancy losses of more than 16 weeks of gestation (130 stillbirths, 97 induced abortions and 10 early neonatal deaths). Cartilage culture was performed in 222 samples and placental culture was initiated in 224. The overall culture success rate was 83.5%, 72.3% in stillbirths, 97% in induced abortions and 100% in early neonatal death. An abnormal karyotype was detected in 52 cases: 6.9% in stillbirths, 43.6% in induced abortions and 20% in early neonatal deaths. The rate of discrepancy between the prenatal cytogenetic results in amniotic fluid and the post-termination karyotype was 3%. The tissue of choice for cytogenetic analysis was cartilage in induced abortions and early neonatal death, and placenta in stillbirth. The majority of cases had a chromosome abnormality: multiple congenital anomalies in 74.6%, and a single major anomaly in 9.7%.

[Experimental bladder augmentation with Gore-tex amine: biomechanical, biochemical and biostructural aspects]. / Estudio experimental de la ampliación vesical con lámina de Gore-tex: aspectos biomecánicos, bioquímicos y bioestructurales.

We conducted an experimental study on 20 dogs that were subdivided into two groups: the control group comprised 5 dogs that were submitted to resection of 50% of the bladder; the other group comprised 15 dogs submitted to resection of 50% of the bladder and replacement with Gore-tex patch, which was removed 3 months thereafter in 10 dogs. CPK, creatinine, ions, and urinary pH values were determined and urine cultures were performed. The biomechanical parameters of the bladder wall were determined by cystometry. A histological study with hematoxylin-eosin of bladder dome specimens was done. The results showed no increased bladder capacity in the animals that received the Gore-tex implant versus the control animals, chiefly due to the necrosis produced by stiffness of the Gore-tex implant. This necrosis was associated with diminished elasticity (due to collagen) and substitution of the muscle fibers by other viscoelastic fibers with a higher elastic constant. Three months following removal of the Gore-tex implant, we observed fibrotic reaction, secondary calcification of the necrotic bladder wall and inflammatory phenomena that impeded muscle regeneration. The urinary pH increased significantly in the dogs that received the Gore-tex implant. The foregoing results show that although the Gore-tex patch is impermeable and resistant to infection, it does not have the appropriate biomechanical properties.

Complications of Operative Hysteroscopy

We conducted a retrospective study of 324 operative hysteroscopies performed from January 1993 to December 1995 to evaluate and analyze possible complications. Our complication rate was 5.2%, with uterine perforation being the most common at 1.8%. We had no cases of water intoxication.