Thermal refugia reinforce macroalgal resilience against climate change in the southeastern Bay of Biscay.

Rising global temperatures present unprecedented challenges to marine ecosystems, demanding a profound understanding of their ecological dynamics for effective conservation strategies. Over a comprehensive macroalgal assessment spanning three decades, we investigated the spatiotemporal evolution of shallow-water benthic communities in the southern Bay of Biscay, uncovering climate-resilient areas amidst the ongoing phase shift in the region. Our investigation identified seven locations serving as potential climate refugia, where cold-affinity, canopy-forming macroalgal species persisted and community structure was similar to that observed in 1991. We unveiled a clear association between the emergence of these refugia, sea surface temperature (SST), and the Community Temperature Index, positioning SST as a significant driver of the observed phase shift in the region. Warming processes, defined as tropicalization (increase of warm-affinity species) and deborealization (decrease of cold-affinity species), were prominent outside refugia. In contrast, cooling processes, defined as borealization (increase of cold-affinity species) and detropicalization (decrease of warm-affinity species), prevailed inside refugia. Refugia exhibited approximately 35% lower warming processes compared to non-refuge areas. This resulted in a dominance of warm-affinity species outside refugia, contrasting with the stability observed within refugia. The persistence of canopy-forming species in refuge areas significantly contributed to maintaining ecosystem diversity and stability. These findings underscored the pivotal role of climate refugia in mitigating climate-driven impacts. Prioritizing the protection and restoration of these refugia can foster resilience and ensure the preservation of biodiversity for future generations. Our study illustrates the importance of refining our understanding of how marine ecosystems respond to climate change, offering actionable insights essential for informed conservation strategies and sustainable environmental management.

Direct effects of Xenorhabdus spp. cell-free supernatant on Meloidogyne incognita in tomato plants and its impact on entomopathogenic nematodes.

Entomopathogenic Xenorhabdus spp. bacteria, symbiont of the nematode Steinernema spp., shows potential for mitigating agricultural pests and diseases through bioactive compound production. The plant-parasitic nematode (PPN) Meloidogyne incognita affects the yield and quality of numerous crops, causing significant economic losses. We speculate that Cell-Free Supernatants (CFS) from Xenorhabdus spp. could reduce the impact of the root-knot nematode (RKN) M. incognita without negatively affecting entomopathogenic nematodes (EPNs), which are considered beneficial organisms. This study explored the activity of seven CFS against M. incognita (two populations, AL05 and Chipiona) and their possible effects on EPNs. The in vitro impact of CFS at 10 %, 40 %, and 90 % concentrations on nematode motility at four and 24 h were tested on the PPN M. incognita and two EPNs, S. feltiae and H. bacteriophora. Additionally, EPN viability and virulence were evaluated at two and five days. On the other hand, tomato plant-mesocosm experiments examined the activity of four CFS on M. incognita reproductive capacity and EPN virulence. In vitro exposure of M. incognita to 90 % concentration of CFS resulted in reductions of activity over 60 % after four hours of expossure in four out of seven CFS. In the in vitro evaluation of two species of EPNs, none of the CFS affected the activity across any tested doses after four hours of exposure nor after 24 h. Plant-mesocosm experiments showed that CFS application significantly reduced RKN galls, egg masses, and galling index. However, the virulence of both EPN species decreased 15 days after application, with a significant impact on S. feltiae. Overall, these findings suggest that CFS could be used as a bio-tool against M. incognita in tomato crops, mitigating its impact on plant growth. However, this study also highlights the necessity of investigating the effects of CFS on non-target organisms.

A Cluster Analysis of Neuropsychological Impairment in Borderline Personality Disorder: Identifying a Neurocognitive Subtype Linked to Attention Deficit Hyperactivity Disorder.

INTRODUCTION: Cognitive impairment associated with borderline personality disorder (BPD) has been consistently demonstrated. However, a specific neuropsychological profile has not yet been established for this disorder, maybe due to the heterogeneity of BPD. The aim of this work is the search for distinct neuropsychological subtypes among patients with BPD and for the association of neuropsychological subgroups with specific clinical characteristics. METHODOLOGY: One hundred fifteen patients with BPD diagnosis received an extensive neuropsychological evaluation assessing attentional, memory and executive functions indexes. For subtyping strategies, a cluster analysis of neuropsychological BPD distribution was performed. Central clinical dimensions of BPD were measured and analysed in relation with the obtained neuropsychological clusters. RESULTS: Two clusters were found: Cluster 1 showed a significantly lower score on the working memory index, and Cluster 2 had significantly worse overall executive performance, response inhibition and planning abilities. Patients in the neurocognitive Cluster 2 showed significantly higher clinical deficits of attention as measured with subscales of the CAARS attention deficit hyperactivity disorder (ADHD) index (F = 2.549, p < 0.005, d = 11.49). CONCLUSIONS: Two neuropsychological clusters of patients were found in the BPD sample: Cluster 1 patients showed greater impairment in working memory, while Cluster 2 patients had greater deficits of executive functioning, particularly for response inhibition and planning. In addition, BPD patients with greater executive deficits presented greater levels of ADHD clinical features. These findings might also facilitate earlier diagnosis of severe BPD patient profiles and to establish more personalized treatment based on neurocognitive stimulation.

Usefulness of a Simple Immunohistochemical Staining Technique to Differentiate Anti-p200 Pemphigoid From Other Autoimmune Blistering Diseases: A Report of 2 Cases. / Descripción de 2 casos de penfigoide anti-p200. Utilidad de una técnica inmunohistoquímica sencilla en el diagnóstico diferencial con otras enfermedades ampollosas autoinmunes.

Anti-p200 pemphigoid is a rare autoimmune subepidermal blistering disease characterized by the presence of circulating immunoglobulin G antibodies directed against laminin gamma-1, a 200-kDa protein located in the lamina lucida of the basement membrane. We review the clinical, histopathological and immunological characteristics of the first 2 cases described in Spain. Anti-p200 pemphigoid shares histopathological and immunopathological findings with epidermolysis bullosa acquisita, the main entity in the differential diagnosis. However, its management follows the same guidelines as those used for bullous pemphigoid. The diagnosis is confirmed by immunoblotting, which is a complex technique available in few centers. We propose the immunohistochemical detection of collagen type IV on the floor of the blister, combined with standard immunofluorescence techniques, as a simple, accessible alternative to differentiate anti-p200 pemphigoid from epidermolysis bullosa acquisita.

[Conservative management of liver trauma and its complications: current gold-standard]. / Tratamiento conservador de los traumatismos hepáticos y sus complicaciones: gold-standard actual.

INTRODUCTION: The liver is the second most frequently involved organ in abdominal trauma in children. The aim of this study was to review the characteristics of liver traumas (LT) in children, its treatment and complications. MATERIAL AND METHODS: Retrospective study of patients with LT treated between 2010-2014. We analyzed data regarding diagnosis, conservative management (CM), complications and treatment. RESULTS: Twenty-four patients of LT with a mean age of 9.8 years (SD: 3.4) were treated at our center. Liver injury degrees according to the Organ Injury Scale of American Association for Surgery of Trauma (AAST) were: grade I (4), grade II (6), grade III (8), grade IV (5) and grade V (1). CT angiography was performed in 23 patients. Four of the six patients with initial hemodynamic instability required blood transfusion; of those, two required angioembolization for active bleeding in extrahepatic locations and a third required damage control surgery. Three patients presented late-onset complications: 2 large size bilomas which underwent spontaneous resolution and a third patient with a right biloma and section of the left bile duct who required a multidisciplinary approach. Median hospital stay was 6 days (r 1-92). With a mean follow-up of 17.75 months (SD: 16.35) (r: 2-57) long-term survival was 96%. The patient who received surgery died due to a post-traumatic brain injury. CONCLUSION: CM seems to be the treatment of choice in LT regardless of injury degree. Surgery should be reserved for cases refractory to CM due to the associated high mortality.

INTRODUCCION: El hígado es el segundo órgano más afectado en traumatismos abdominales en edad pediátrica. El objetivo de este trabajo es revisar las características de los traumatismos hepáticos (TH), su tratamiento y complicaciones. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con TH atendidos entre 2010 -2014. Analizamos datos referentes al diagnóstico, tratamiento conservador (TC), complicaciones y tratamiento de las mismas. RESULTADOS: Se trataron 24 casos de TH con una edad media de 9,8 años (DS: 3,4). Los grados de lesiones hepáticas según la Organ Injury Scale of American Association for Surgery of Trauma (AAST) fueron: grado I (4), grado II (6), grado III (8), grado IV (5) y grado V (1). Se realizó angio-TC en 23 pacientes. Cuatro de los 6 pacientes que presentaron inestabilidad hemodinámica inicial requirieron transfusión de hemoderivados; de éstos, 2 requirieron angioembolización por sangrado activo extrahepático y un tercero se intervino de forma urgente. Tres pacientes presentaron complicaciones tardías: 2 bilomas de gran tamaño que se resolvieron espontáneamente y un biloma derecho con sección de vía biliar izquierda que requirió un abordaje multidisciplinar. En los 3 casos se trataba de traumatismos de alto grado (2 grado IV, 1 grado V). La mediana de estancia hospitalaria fue de 6 días (r: 1-92). Con una media de seguimiento de 17,75 meses (DS: 16,35) (r: 2-57) la supervivencia global fue del 96%. El paciente que requirió cirugía falleció por el traumatismo craneoencefálico asociado. CONCLUSIONES: El TC parece ser de primera elección en los TH independientemente del grado aunque no está exento de complicaciones. La cirugía debe reservarse para los casos refractarios al TC dada la alta mortalidad que conlleva.

Cross-Cultural Adaptation of the Urticaria Control Test From German to Castilian Spanish.

INTRODUCTION: The clinical concept of urticaria embraces a heterogeneous group of conditions classified according to their clinical course as acute (lasting less than 6 weeks) or chronic (lasting 6 weeks or more). Chronic urticaria may be either spontaneous or induced. Few tools are available for monitoring the various clinical forms of this disease or for evaluating its impact on quality of life. The recently developed Urticaria Control Test to evaluate disease control is available in German, the original language, and American English. OBJECTIVE: To culturally adapt the long and short versions of the Urticaria Control Test to Castilian Spanish to ensure equivalence between the translated items and those of the original version. MATERIAL AND METHODS: To translate the Urticaria Control Test we followed the International Society for Pharmacoeconomics and Outcomes Research good practice guidelines, starting with forward translation and moving through back translation and cognitive debriefing steps. RESULTS: Three items were modified when the first Spanish version, translated from German, was discussed (cognitive debriefing). The revised translation was then translated back to German and sent to the Urticaria Control Test authors, who modified one item they considered had acquired a different focus through translation. A third Spanish version was then prepared and after minor proofreading changes was considered definitive. CONCLUSIONS: This study was the first step in making it possible to use the Urticaria Control Test questionnaire in Castilian Spanish. The next step will be to validate the translated questionnaire.

Split-plot marine experiment to assess ecophysiological responses of Gelidium corneum assemblages.

Canopy-forming macroalgae are facing large declines due to climate change worldwide. The foundation species Gelidium corneum (Hudson) J.V. Lamouroux has shown a long-term decline in the Southeastern Bay of Biscay. We conducted an in situ experiment to investigate the combined effect of solar radiation and nutrient availability on the photosynthetic acclimation and growth of this macrophyte, and on the species richness and diversity of the assemblages that it forms. Photochemical stress in G. corneum was found to be greater at the end of the study, probably as a result of a prolonged exposure to high irradiance (PAR and UVR) and due to high temperatures during summer. We found an acclimation of G. corneum specimens to summer light and thermal conditions through dynamic/reversible photoinhibition and a decrease in photosynthetic efficiency. Nutrients may also have had a positive effect in dealing with the negative effects of these stressors. Under ongoing global climate change and projections for the future, further research will be needed to better understand the effects not only on canopy forming species but also on the whole community and thus on the functioning of the ecosystem.

The thermal journey of macroalgae: Four decades of temperature-induced changes in the southeastern Bay of Biscay.

Global warming is triggering significant shifts in temperate macroalgal communities worldwide, favoring small, warm-affinity species over large canopy-forming, cold-affinity species. The Cantabrian Sea, a region acutely impacted by climate change, is also witnessing this shift. This study delved into the impacts of increasing sea surface temperature on the subtidal macroalgal communities in the southeastern Bay of Biscay over the last four decades, by using data from the years 1982, 2007, 2014, and 2020. We found that temperature has shaped the community structure, with warm-affinity species steadily displacing their cold-affinity counterparts. Notably, new communities exhibited a profusion of smaller algal species, explaining the observed increased biodiversity within the area. In the last period investigated (2014-2020), we observed a partial recovery of the communities, coinciding with cooler sea surface temperatures. Shallow algal communities were more reactive to temperature variations than deeper communities, possibly associated with higher exposure to increased temperatures. Our study offered insights into the intricate relationship between the changes in ocean temperature and algal species in the southeastern Bay of Biscay, shedding light on the ongoing ecological shifts in this region.

Short-term response of macroalgal communities to ocean warming in the Southern Bay of Biscay.

Climate change is causing significant shifts in biological communities worldwide, including the degradation of marine communities. Previous research has predicted that southern Bay of Biscay canopy-forming subtidal macroalgal communities will shift into turf-forming Mediterranean-like communities by the end of the century. These predictions were based on a community-environment relationship model that used macroalgal abundance data and IPCC environmental projections. We have tested the short-term accuracy of that model by resampling the same communities and locations four years later and found the short-term predictions to be consistent with the observed communities. Changes in sea surface temperature were positively correlated with changes in the Community Temperature Index, suggesting that macroalgal communities had responded quickly to global warming. The changes over four years were significant, but canopy-forming macroalgae were more resilient in local sites with favourable temperature conditions. Our study demonstrated that updating predictive models with new data has the potential to yield reliable predictions and inform effective conservation strategies.

A spatially-modelled snapshot of future marine macroalgal assemblages in southern Europe: Towards a broader Mediterranean region?

The effect of climate change on species distribution has been the focus of much recent research, but the community-level approach remains poorly studied. Our investigation applies a present assemblage-environment relationship model for the first time to the predict changes in subtidal macroalgal assemblages in the northern Iberian Peninsula under the RCP 4.5 and RCP 8.5 climate scenarios by 2100. Water temperature is the most relevant factor in shaping assemblage distribution, whilst nutrient availability plays a secondary role. The results partially support our hypothesis that there may well be a potential meridionalisation of northern Iberian assemblages in the future. Under the most pessimistic scenario, the model projects that the north-western assemblages will remain distinct from the rest, whereas the central and eastern assemblages of the north coast of the Iberian Peninsula will come to resemble those of the Mediterranean region more closely than those of the northwest coast. This research may help predict how the biodiversity of the coastal ecosystem will respond to new environmental conditions. This is essential information for developing proper management and conservation policies.

Prediction of total and volatile acidity in red wines by Fourier-transform mid-infrared spectroscopy and iterative predictor weighting.

Fourier-transform mid-infrared (FT-MIR) spectroscopy, combined with partial least-squares (PLS) regression and IPW as feature selection method, was used to develop reduced-spectrum calibration models based on a few IR bands to provide near-real-time predictions of two key parameters for the characterization of finished red wines, which are essential from a quality assurance standpoint: total and volatile acidity. Separate PLS calibration models, correlating IR data (only considering those regions showing a high signal to noise ratio) with each response studied, were developed. Wavenumber selection was also performed applying IPW-PLS to take into account only significant predictors, in an attempt to improve the quality of the final models constructed. Using both PLS and IPW-PLS regression, prediction of the two responses modelled was performed with very high reliability, with RMSECV and RMSEP values on the order of 1% (comparable in terms of accuracy to the results provided by the respective reference analysis methods). An important advantage derived from the application of the IPW-PLS method had to do with the low number of original variables needed for modelling both total acidity (22 significant wavenumbers) and volatile acidity (only 11 selected predictor variables), in such a way that variable selection contributed to enhance the stability and parsimony properties of the final calibration models. The high quality of the calibration models proposed encourages the feasibility of implementing them as a fast and reliable tool in routine analysis for the determination of critical parameters for wine quality.

[Knowledge And Experience In Gender Violence Of Tutors And Trainees Of Galicia Family Medicine]. / Conocimiento y experiencia en violencia de género de las/os tutoras/es médicas/os y residentes de medicina de familia de Galicia.

OBJECTIVE: To analyse the level of preparation, knowledge and experience of gender violence of medical tutors and family medicine trainees of the Teaching Units of Family and Community Care of Galicia. METHODS: Descriptive cross-sectional study conducted in the 7 Teaching Units of Family and Community Care in Galicia. The Physician Readiness Manage Intimate Violence Survey (PREMIS), in its validated version in Spanish was used. This survey allows the collection of information from primary health care professionals about their attitudes, knowledge, and practices as regards gender violence. A descriptive and comparative statistical analysis was performed on the data. RESULTS: Out of a total of 159 questionnaires received, 72.32% came from women, and 59.1% of the responses were from doctors / tutors. It was noted that there were statistically significant differences in the detection / diagnosis of violence by those professionals who were aware of the gender violence protocol or who had received training in this area (P<.01). In the self-perception of gender violence training, statistically significant worse results were observed in those professionals with greater care burden (P<.05). CONCLUSIONS: Having received training or knowing the health care protocol on gender violence is associated with greater detection of cases of gender violence. There has been a deficit in training in gender-based violence both in tutors and in family medicine residents, especially in those with greater care burden, so it is a priority to develop medical training strategies in this field.

Ecological monitoring of intertidal phytobenthic communities of the Basque Coast (N. Spain) following the Prestige oil spill.

Following the Prestige oil spill, six-monthly samplings (spring and autumn) of intertidal macroalgal assemblages were carried out from 2004 to 2006 in twelve locations along the Basque coast. Macroalgal species appeared to be little modified, but species richness, diversity, and algal cover were significantly lower in the first year of the study, so it cannot be ruled out that the arrival of oil on the Basque coast might have had a damaging effect on intertidal communities. On the other hand, no significant differences were detected between locations slightly and moderately affected by oil in any of the structural parameters considered. By contrast, significant differences were detected between locations within each oiling level that indicate that other natural environmental factors play a greater role in the differences between locations than the oiling level. Likewise, significant differences were detected between areas within each location which were not consistent with time, indicating that communities are highly heterogeneous in species richness, diversity and algal cover at the scale of tens of meters. The dominant Corallina elongata and most of the accompanying species did not show significant year-on-year differences in terms of cover. Also, there were no differences between the two oiling levels. Analyses revealed a high spatial variability at the scale of kilometers (locations) and tens of meters (areas) for most of the taxa. The results obtained provide detailed quantitative data on intertidal phytobenthic assemblages of the Basque coast at different spatial and temporal scales that were hitherto unavailable for the region.

Multiple independent second-site mutations in two siblings with somatic mosaicism for Wiskott-Aldrich syndrome.

Wiskott-Aldrich syndrome (WAS) is an X-linked primary immunodeficiency disorder associated with microthrombocytopenia, eczema, autoimmunity and predisposition to malignant lymphoma. Although rare, few cases of somatic mosaicism have been published in WAS patients to date. We here report on two Ukrainian siblings who were referred to us at the age of 3 and 4 years, respectively. Both patients suffered from severe WAS caused by a nonsense mutation in exon 1 of the WAS gene. In both siblings, flow cytometric analysis revealed the presence of Wiskott-Aldrich syndrome protein (WASp)-positive and WASp-negative cell populations among T and B lymphocytes as well as natural killer (NK) cells. In contrast to previously described cases of revertant mosaicism in WAS, molecular analyses in both children showed that the WASp-positive T cells, B cells, and NK cells carried multiple different second-site mutations, resulting in different missense mutations. To our knowledge, this is the first report describing somatic mosaicism in WAS patients caused by several independent second-site mutations in the WAS gene.

Monitoring of substrate and product concentrations in acetic fermentation processes for onion vinegar production by NIR spectroscopy: value addition to worthless onions.

Wastes and by-products of the onion-processing industry pose an increasing disposal and environmental problem and represent a loss of valuable sources of nutrients. The present study focused on the production of vinegar from worthless onions as a potential valorisation route which could provide a viable solution to multiple disposal and environmental problems, simultaneously offering the possibility of converting waste materials into a useful food-grade product and of exploiting the unique properties and health benefits of onions. This study deals specifically with the second and definitive step of the onion vinegar production process: the efficient production of vinegar from onion waste by transforming onion ethanol, previously produced by alcoholic fermentation, into acetic acid via acetic fermentation. Near-infrared spectroscopy (NIRS), coupled with multivariate calibration methods, has been used to monitor the concentrations of both substrates and products in acetic fermentation. Separate partial least squares (PLS) regression models, correlating NIR spectral data of fermentation samples with each kinetic parameter studied, were developed. Wavelength selection was also performed applying the iterative predictor weighting-PLS (IPW-PLS) method in order to only consider significant spectral features in each model development to improve the quality of the final models constructed. Biomass, substrate (ethanol) and product (acetic acid) concentration were predicted in the acetic fermentation of onion alcohol with high accuracy using IPW-PLS models with a root-mean-square error of the residuals in external prediction (RMSEP) lower than 2.5% for both ethanol and acetic acid, and an RMSEP of 6.1% for total biomass concentration (a very satisfactory result considering the relatively low precision and accuracy associated with the reference method used for determining the latter). Thus, the simple and reliable calibration models proposed in this study suggest that they could be implemented in routine applications to monitor and predict the key species involved in the acetic fermentation of onion alcohol, allowing the onion vinegar production process to be controlled in real time.

Simultaneous determination of potassium and total fluoride in toothpastes using a SIA system with two potentiometric detectors.

A sequential injection analysis (SIA) system has been developed for the first time to quantify potassium and total fluoride in toothpastes and gels used to prevent both dentinal hypersensitivity and dental caries. To enable this simultaneous determination, potentiometric detection, using a conventional fluoride electrode and a tubular potassium selective electrode, formed by a PVC membrane containing valinomycin as ionophore, was carried out. A manifold that uses a three-way solenoid valve was designed. The former under binary sampling conditions, provides reproducible mixing ratios of two solutions. This fact facilitates that the system automatically generates, on-line, the calibration curves required by the analytical procedure. The calibration ranged from 1.0 x 10(-4) to 1.0 x 10(-3) mol L(-1) for both potassium and total fluoride determinations. The R.S.D. (11 readings) resulted to be less than 1.5% for both determinations. Off-line studies related to the dissolution of the solid samples, the transformation of monofluorophosphate in fluoride, the elimination of organic matrix interference onto the plastic membrane of the potassium electrode, and the selection of the most adequate TISAB solution for fluoride determination, were also considered. A sampling rate of 18 samples h(-1) for both determinations was attained, their precisions and accuracies being statistically indistinguishable from those achieved by atomic emission spectroscopy (for potassium determination) and by a conventional batch potentiometry (for total fluoride determination) adopted as reference techniques.

Laparoscopic partial nephrectomy with prior superselective embolisation as treatment for giant renal angiomyolipoma. / Nefrectomía parcial laparoscópica previa embolización supraselectiva como tratamiento de angiomiolipomas renales gigantes.

OBJECTIVE: Cases of giant renal angiomyolipoma (>9cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumour extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach. MATERIAL AND METHODS: We present 3 cases of giant angiomyolipoma (10 12 and 14cm) treated with a combined approach: superselective embolisation and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals. RESULTS: None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications. CONCLUSIONS: The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischaemia time.

[Volume determinations of the whole prostate and of the adenoma by transrectal ultrasound: correlation with surgical specimen]. / Correlación ecográfico-anatómica de la medición del volumen prostático total y de la zona transicional mediante ecografía transrectal.

OBJECTIVE: We evaluated whether preoperative transrecta ultrasound (TRUS) mesaurements of the transition zone (TZ) and total prostate volumen predict real prostatic weight. MATERIAL AND METHODS: We compare estimated TRUS volumes with surgical specimen weight, in surgically treated patients with localized prostate cancer (group A, n = 33) or benign prostatic hyperplasia (group B, n = 37). The volume was calculated by the ellipsoid formula. Both measurements were compared with surgical specimen weight, assuming 1 as specific prostate weight. RESULTS: Group A: mean prostate measured volume was 38.6 cc. (SD 22.7), mean RP specimen weight was 54,2 g (SD 27.2) (p = 0.001). Total estimated prostate volume underestimated prostatectomy specimen weight by 29%. In order to adequate the estimated volume to the specimen weight, we calculated the formula: estimated prostate weight = 0.95 x prostatic measured volume + 17,657 (p = 0.005). Group B: mean TZ measured volume was 62.8 cc. (SD 23.3), mean adenomectomy specimen weight was 79.9 g (SD 45.9) (p = 0.001). TZ estimated volume underestimated adenomectomy specimen weight by 21%. In order to adequate the estimated volume to the specimen weight, we calculated the formula: estimated TZ weight = 1.67 x TZ measured volume - 24,768 (p = 0.04). CONCLUSIONS: We found significative differences between TRUS measured volumes and real weight of surgical specimen. These differences could be corrected by simple formulas that allow to minimize the observed underestimations.

Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma.

Mortality due to epidural hematoma is virtually restricted to patients who undergo surgery for that condition while in coma. The authors have analyzed the factors influencing the outcome of 64 patients who underwent epidural hematoma evacuation while in coma. These patients represented 41% of the 156 patients operated on for epidural hematoma at their centers after the introduction of computerized tomography (CT). Eighteen patients (28.1%) died, two (3.1%) became severely disabled, and 44 (68.8%) made a functional recovery. The mortality rate for the entire series was 12%, significantly lower than the 30% rate observed when only angiographic studies were available. A significant correlation was found between the final result and the mechanism of injury, the interval between trauma and surgery, the motor score at operation, the hematoma CT density (homogeneous vs. heterogeneous), and the hematoma volume. The patient's age, the course of consciousness before operation (whether there was a lucid interval), and the clot location did not correlate with the final outcome. The mortality rate was significantly higher in patients operated on within 6 hours or between 6 and 12 hours after injury than in those undergoing surgery 12 to 48 hours after injury. Compared with the patients operated on later, the patients undergoing surgery in the early period were, on the average, older and had more rapidly developing symptoms, more pupillary changes, lower motor scores at surgery, larger hematomas, a higher incidence of mixed CT density clots, more severe associated intracranial lesions, and higher postoperative intracranial pressure (ICP). The mechanism of trauma seems to influence the course of consciousness before and after surgery. Passengers injured in traffic accidents had a lower incidence of a lucid interval and longer postoperative coma than patients with low-speed trauma, suggesting more frequent association of diffuse white matter-shearing injury. The duration of postoperative coma correlated with the morbidity rate in survivors. Forty-eight patients (75%) had one or more associated intracranial lesions, and 70% of these required treatment for elevation of ICP after hematoma evacuation. An ICP of over 35 mm Hg strongly correlated with poor outcome; administration of high-dose barbiturates was the only effective means for lowering ICP in nine of 15 patients who developed severe intracranial hypertension after surgery. This study attempts to identify patients at greater risk for presenting postoperative complications and to define a strategy for control CT scanning and ICP monitoring.