Conservative management of high-grade renal trauma.

INTRODUCTION: Renal trauma is the most common of urological trauma and accounts for up to 5% of all. The AAST scale is the most widely used to assess renal trauma. This study focuses on high-grade trauma, whose treatment has evolved towards a conservative approach, with techniques such as angioembolization. The aim is to describe the evolution in the management of high-grade renal trauma in all patients treated at La Paz University Hospital from 2001 to 2022. METHODS: A descriptive retrospective study was conducted on patients treated at the hospital. The study was divided into two periods (2001-2010 and 2011-2022). A total of 285 patients with renal trauma were collected, of which 54 were high grade. The main variable is the type of management, conservative (embolization) or interventional through nephrectomy. RESULTS: In the completed series, there was a decrease in radical nephrectomy in high-grade renal trauma from 50% to 13.8% over time, with an increase in embolization from 23,1% to 44,8%. In patients with isolated renal trauma, those treated with embolization increased from 28.6% to 69.2%, while those undergoing radical/partial nephrectomy decreased from 42.8% to 7.69%. CONCLUSION: The management of renal trauma has evolved over the years in our center. The number of patients treated by embolization has increased, while the number of complications and nephrectomies has decreased.

Randomized clinical trial on the use of IMAGE1 S LIGHT (SPIES) vs. white light in the prevention of recurrence during transurethral resection of bladder tumors: Analysis after 12-month follow-up.

INTRODUCTION: The improved image resolution of IMAGE1 S technology will increase tumor detection, achieve a greater number of complete resections, and would probably have an impact on the reduction of recurrences. AIM: The primary objective was to compare the recurrence rates of IMAGE1 S vs. white light during transurethral resection of the bladder (TUR); the secondary objective was to compare the complication rates according to Clavien-Dindo (CD) at 12 months of follow-up. METHODS: Prospective, randomized 1:1, blinded clinical trial. Recurrence and complication rates according to CD were analyzed using chi-square/U Mann-Whitney tests and recurrence-free survival (RFS) using Kaplan-Meier curves. The European Association of Urology (EAU) 2021 scoring model was used. RESULTS: The analysis included 103 participants; 49 were assigned to the IMAGE1 S group and 54 to the white light group. Recurrence rates were 12.2% and 25.9%, respectively (P = .080). The low and intermediate risk group had a lower recurrence rate with IMAGE1 S (7.7% vs. 30.8%, P = .003) and a higher RFS with IMAGE1 S (85.2% vs. 62.8% Log Rank: 0.021), with a Hazard Ratio of 0.215 (95% CI: 0.046-0.925). No differences were observed in the high and very high-risk groups. Complications were mostly grade I and rates were similar between both groups (IMAGE1 S 20.4% vs. white light 7.4% P = .083). CONCLUSIONS: There were no differences in the recurrence rates between groups. However, the low and intermediate risk group had a lower recurrence rate with IMAGE1 S. In addition, perioperative complication rates were not higher.

Valores hematológicos de referencia en caninos adultos aparentemente sanos, que concurren a una clínica privada de Asunción / Hematological reference values in apparently healthy adult dogs attending a private clinic in Asuncion

El hemograma es el examen de laboratorio de mayor uso diagnóstico en el canino, por lo que se hace necesario disponer de valores referenciales adecuados para poder interpretar correctamente los resultados y así obtener una conclusión válida. El presente estudio tiene como objetivo determinar los valores hematológicos en caninos adultos aparentemente sanos en la ciudad de Asunción. Este estudio descriptivo de corte transversal se desarrolló en un grupo de caninos aparentemente sanos, pacientes habituales de la Clínica “Tacuary 2”. Se determinaron los valores hematológicos de 100 caninos adultos de 23 razas diferentes por técnicas manuales. Los valores de referencia se hallaron utilizando el método clásico o parámetrico que se calcula en base al valor de la media, más menos el doble de la desviación típica (x ± 2s). Los valores fueron número de eritrocitos (4,3 - 7,1 x 106/µL), hemoglobina (9,2 - 15,6 g/dL), hematocrito (28,2 - 48,2 %), VCM (63 - 71 fL), CHCM (30 - 35 g/dL), HCM (20 - 23 pg), número de leucocitos (7,8 - 12,5 x 103/µL), neutrófilos segmentados (62 - 86%), (5,7 - 9,3 x 103/µL), neutrófilos en banda (0 -2%), (0 - 231 x 103/µL), eosinófilos (0 - 5 %), (0 - 0,56 x 103/µL), linfocitos (11 - 29%), (1 - 3 x103/µL), monocitos (0 - 7,6%), (0 - 0.4 x 103/µL), proteína total (4,5 - 7,05 g/L).Llama la atención los valores más bajos de eritrocitos, hemoglobina, hematocrito y proteína total de los individuos estudiados al compararlos a los reportados por la literatura.

The hemogram is the laboratory test most commonly used for diagnosis in dogs, therefore it is necessary to have adequate reference values to interpret correctly the results and obtain a valid conclusion.The objective of the present study is to determine the hematological values in apparently healthy adult dogs in the city of Asuncion. This cross-sectional descriptive study was performed in a group of apparently healthy dogs, regular patients of the Clinic "Tacuary 2" The hematologic values of 100 adult dogs of 23 different breeds were determined by manual techniques.The reference values were found using the classical or parametric method which is calculated based on the mean value plus minus twice the standard deviation (x±2s). The values were number of erythrocytes (4.3 - 7.1 x 106/µl), hemoglobin (9.2 - 15.6 g/dl), hematocrit (28.2 - 48.2%), MCV (63 - 71 fL), MCHC (30 - 35 g/dL), MCH (20 - 23 pg), number of leukocytes (7.8 - 12.5 x 103/µL), segmented neutrophils (62 - 86%), (5.7 - 9.3 x 103/µL), band neutrophils (0 -2%), (0 - 231 x 103/µL), eosinophils (0 - 5%), (0 to 0.56 x 103/µL), lymphocytes (11 - 29%), (1 - 3 x103/µL), monocytes (0 - 7.6%) (0 - 0.4 x 103/µL), total protein (4.5 to 7.05 g/L). It should be noticed the lower values of erythrocytes, hemoglobin, hematocrit and total protein of the study population when compared to those reported in the literature.

Menstrual cycle worsening of epileptic seizures in women with symptomatic focal epilepsy

INTRODUCTION: Hormonal fluctuation is responsible for worsening of epileptic seizures during the menstrual cycle. OBJECTIVE: To identify irregularities in the menstrual cycles of women with mesial temporal lobe epilepsy (MTLE) and extratemporal focal epilepsy (ETFE) and correlate the frequency of seizures during the menstrual cycles. METHOD: We evaluated prospectively women in the menacme with MTLE and ETFE. Calendars were provided for these patients, and they were asked to mark their seizure frequency according to the menses. Calendars were reviewed in each routine medical appointment. RESULTS: Thirty-nine patients with MTLE and 14 with ETFE were evaluated. We registered 211 cycles in the patients with MTLE and 49 in those with ETFE. Irregular menstrual cycles were found in 28 (28/39, 71.7%) patients with MTLE and 6 (6/14, 42.8%) with ETFE (p=0.052). Premenstrual seizure worsening was observed in 46 (21.8%) patients with MTLE and 9 (18.3%) with ETFE (p=0.596). Menstrual worsening was observed in 47 (22.2%) patients with MTLE and 15 (30.6%) with ETFE (p=0.217). Ovulatory worsening was observed in 36 (17%) patients with MTLE and 13 (26.5%) with ETFE (p=0,126). Catamenial worsening was observed in 58 (27.4%) of the patients with MTLE and in 17 (34.7%) of the patients with ETFE (p=0.315). CONCLUSION: There was no difference between the group of patients with MTLE and ETFE regarding the frequency of irregular cycles and seizure worsening during the premenstrual, menstrual, catamenial or ovulatory periods.

INTRODUÇÃO: Admite-se que a flutuação hormonal seja a responsável para a piora de crises epilépticas no período catamenial. OBJETIVO: Identificar irregularidades nos ciclos menstruais de mulheres com epilepsia de lobo temporal mesial (ELTM) e epilepsia focal extratemporal (EFET); e relacionar a frequencia de crises durante o ciclo menstrual. MÉTODO: Avaliamos mulheres na menacme, que apresentem quadro clínico laboratorial compatível com ELTM e EFET. Foram fornecidos calendários para estas pacientes e instruídas para preenchimento correto da menstruação e das crises epilépticas e serão revistos em cada consulta médica rotineira. RESULTADOS: Foram avaliadas 39 pacientes com ELTM e 14 com EFET. Registramos 211 ciclos nas pacientes com ELTM e 49 nas com EFET. Ciclos menstruais irregulares foram apresentados por 28 (71,7%) pacientes com ELTM e 14 (42,8%) com EFEP (p=0,052). Piora pré-menstrual foi observada em 46 (21,8%) pacientes com ELTM e 9 (18,3%) com EFET (p=0,596). Piora menstrual foi observada em 47 (22,2%) pacientes com ELTM e 15 (30,6%) com EFET (p=0,217). Piora ovulatória foi observada em 36 (17%) pacientes com ELTM e 13 (26,5%) com EFET (p=0,126). Piora catamenial foi observada em 58 (27,4%) das pacientes com ELTM e em 17 (34,7%) das pacientes com EFET (p=0,315). CONCLUSÃO: Não houve diferença entre os grupos de pacientes com ELTM e EFET quanto à freqüência de ciclos irregulares e piora das crises nos períodos pré-menstrual, menstrual, catamenial ou ovulatório.