Comparación del tiempo operatorio y complicaciones entre la pieloplastia laparoscópica convencional y robótica / Comparison of the Operation Time and Complications between Conventional and Robotic-Assisted Laparoscopic Pyeloplasty

Objetivo: Comparar los diferentes tiempos en que podemos dividir la pieloplastia laparoscópica convencional y robótica. Comparar la tasa de complicaciones entre ambos procedimientos. Material y métodos: Estudio retrospectivo de los pacientes diagnosticados de estenosis de la unión pieloureteral tratados mediante pieloplastia laparoscópica convencional y robótica con más de un año de seguimiento. Se han grabado y revisualizado todas las intervenciones. Se han medido los diferentes tiempos en que podemos dividir la pieloplastia. Se han recogido todas las complicaciones peri y postoperatorias presentadas por los pacientes. Se aplicaron las pruebas no paramétricas de Kolmogorov-Smirnov y la U de Mann-Whitney para muestras independientes utilizando un nivel de significación de 0.05. Resultados: Han sido válidos 50 pacientes, 33 tratados con laparoscopia convencional y 17 mediante laparoscopia robótica. El tiempo de sutura, tiempo total de la intervención y la estancia hospitalaria han sido menores con una diferencia estadísticamente significativa en la pieloplastia robótica. La pieloplastia robótica ha presentado menor porcentaje de complicaciones (76,5% vs. 48,5%). Las complicaciones más frecuentes fueron las infecciones urinarias, en relación al doble J. Se han producido 2 reestenosis en la laparoscopia convencional y 1 en la robótica. Tasa de éxitos del 93,9% para la laparoscopia convencional y de 94,1% para la robótica. Conclusiones: Aunque la tasa de éxitos es similar en ambos procedimientos, la pieloplastia robótica es un procedimiento más rápido y tiene menos tasas de complicaciones que la laparoscopia convencional (AU)

Objective: To compare the different times into which the convention and robotic-assisted laparoscopic pyeloplasty can be divided. To compare the rate of complications between both procedures. Material and methods: A retrospective study was performed of the patients diagnosed of pyeloureteral junction stenosis and treated with convention and robotic laparoscopic pyeloplasty with more than one year of follow-up. All of the interventions were recorded and visualized. The different times in which the pyeloplasty can be divided were measured. All of the peri- and post-operative complications that occurred by the patients were collected. The non-parametric tests of Kolmogorov-Smirnov and Mann-Whitney U-Test for independent samples were applied using a significance level of 0.05. Results: A total of 50 patients were validated. Thirty three were treated with convention laparoscopy and 17 with robotic laparoscopy. The suture time, total intervention time and time of hospital stay were lower with a statistically significant difference in the robotic-assisted pyeloplasty. The robotic pyeloplasty had a lower percentage of complications (76.5% vs 48.5%). The most frequent complications were urinary infections, in relationship to the double J. Two restenoses occurred in the conventional laparoscopy and one in the robotic-assisted. Success rate was 93.9% for the conventional laparoscopy and 94.1% for the robotic-assisted one. Conclusions: Although the success rate is similar in both procedures, the robotic pyeloplasty is a very fast procedure and has lower rates of complications than the conventional laparoscopy (AU)

[Comparison of the operation time and complications between conventional and robotic-assisted laparoscopic pyeloplasty]. / Comparación del tiempo operatorio y complicaciones entre la pieloplastia laparoscópica convencional y robótica.

OBJECTIVE: To compare the different times into which the convention and robotic-assisted laparoscopic pyeloplasty can be divided. To compare the rate of complications between both procedures. MATERIAL AND METHODS: A retrospective study was performed of the patients diagnosed of pyeloureteral junction stenosis and treated with convention and robotic laparoscopic pyeloplasty with more than one year of follow-up. All of the interventions were recorded and visualized. The different times in which the pyeloplasty can be divided were measured. All of the peri- and post-operative complications that occurred by the patients were collected. The non-parametric tests of Kolmogorov-Smirnov and Mann-Whitney U-Test for independent samples were applied using a significance level of 0.05. RESULTS: A total of 50 patients were validated. Thirty three were treated with convention laparoscopy and 17 with robotic laparoscopy. The suture time, total intervention time and time of hospital stay were lower with a statistically significant difference in the robotic-assisted pyeloplasty. The robotic pyeloplasty had a lower percentage of complications (76.5% vs 48.5%). The most frequent complications were urinary infections, in relationship to the double J. Two restenoses occurred in the conventional laparoscopy and one in the robotic-assisted. Success rate was 93.9% for the conventional laparoscopy and 94.1% for the robotic-assisted one. CONCLUSIONS: Although the success rate is similar in both procedures, the robotic pyeloplasty is a very fast procedure and has lower rates of complications than the conventional laparoscopy.

Los niveles séricos de adenosin deaminasa y ácido úrico se correlacionan en pacientes gestantes con trastornos hipertensivos / Serum levels correlations of the enzyme adenosine deaminase (ADA) and uric acid in pregnant with hypertensive disorders

Objetivo: Evaluar los niveles séricos de la enzima adenosin-deaminasa (ADA) en pacientes gestantes normales y en pacientes con trastornos hipertensivos del embarazo, para determinar su relación con la gravedad del trastorno hipertensivo y con los niveles séricos de marcadores bioquímicos. Método: Se evaluaron pacientes con preeclampsia leve, preeclampsia grave, hipertensión gestacional y embarazadas sanas (n=10 por cada grupo). Se determinaron los niveles de ADA, ácido úrico, creatinina, amonio y enzimas hepáticas. Resultados: Se detectó una elevación en los niveles séricos de ADA en pacientes con preeclampsia y con hipertensión gestacional, en comparación con aquellas que cursaron con un embarazo normal. Los niveles ADA se correlacionaron positivamente con los niveles de ácido úrico y creatinina, más no con la severidad clínica. A su vez los niveles de ácido úrico se asociaron con la creatinina sérica y con la severidad clínica de los trastornos hipertensivos. Se encontró un incremento en los niveles de amonio en los pacientes con preeclampsia, el cual no se correlacionó con los otros marcadores bioquímicos, mientras que los niveles de TGO, TGP y LDH se encontraron significativamente elevados en la preeclampsia grave. Conclusión: Este estudio permite relacionar la actividad de ADA con los trastornos hipertensivos del embarazo, los niveles elevados de amonio con la preeclampsia y los niveles de ácido úrico, TGO, TGP y LDH con la severidad de los trastornos hipertensivos.

Objective: To evaluate serum levels of the enzyme adenosine deaminase (ADA) in normal pregnant and patients with hypertensive disorders induced by pregnancy, in order to determine their relationship with the severity of the hypertensive disorder and with serum biochemical markers. Method: We evaluated patients with mild preeclampsia, severe preeclampsia, gestational hypertension and healthy pregnancy (n=10 per group). We determined the serum levels of ADA, uric acid, creatinine, ammonia and liver enzymes. Results: In patients with preeclampsia and gestational hypertension we detected a rise in serum ADA as compared with those who had undergone a normal pregnancy. ADA levels were positively correlated with uric acid and creatinine serum levels, but not with clinical severity. Uric acid levels were associated with serum creatinine and the clinical severity of hypertensive disorders. We also found an increase in ammonia levels in patients with preeclampsia, which did not correlate with other biochemical markers, while the levels of SGOT, SGPT, and LDH were significantly elevated in severe preeclampsia. Conclusion: This study establishes a link between the activity of ADA with hypertensive disorders of pregnancy, high levels of ammonium with preeclampsia and uric acid, SGOT, SGPT and LDH levels with the severity of hypertensive disorders.

Factores asociados a la infestación intradomiciliaria por Aedes aegypti en el distrito de Tambogrande, Piura 2004 / Associated factors to the intradomiciliary infestation of Aedes aegypti at Tambogrande district, Piura 2004

Objetivos: Determinar los factores asociados para la infestación de las viviendas por Aedes aegypti en el distrito de Tambogrande, Piura. Materiales y métodos: Realizamos un estudio de casos y controles en la capital del distrito de Tambogrande, en diciembre de 2004. Consideramos como vivienda-caso (Vc) a la vivienda positiva a la infestación por Ae. aegypti, y vivienda-control (Vo) a la vivienda negativa a la infestación por Ae. aegypti en por lo menos un año, de acuerdo a los registros de las actividades de control larvario. Por cada caso consideramos dos controles. La encuesta incluyó factores ambientales, sociales y culturales, y se aplicó a la persona encargada del cuidado de la vivienda. Los factores asociados con un valor de p menor que 0,10 en el análisis bivariado, fueron ingresados a un modelo de regresión logística para estimar los OR ajustados y los intervalos de confianza al 95 por ciento (IC). Resultados: Encuestamos 60 Vc y 124 Vo. Los factores asociados encontrados en modelo logístico múltiple fueron la presencia de botellas dentro de la vivienda (OR: 7,66; IC: 2,95-19,84), vivienda ubicada a menos de 200 m de una llantería (OR: 2,90; IC: 1,13-7,48), vivienda ubicada a menos de 200 m. de una maderera (OR: 2,76; IC: 1,14-6,66) y tener un jardín en el interior de la vivienda (OR: 2.31; IC: 0,98-7,48). Tener una trabajadora del hogar en la vivienda fue un factor protector (OR: 0,07; IC: 0,014- 0,37).Conclusiones: Los factores identificados deben ser tomados en cuenta para el desarrollo de programas de controlvectorial en Tambogrande.

Objectives: To determine the associated factors to the intradomiciliary infestation for Ae. aegypti in Tambogrande district, Piura (Northern Coastal of Peru). Material and methods: We conducted a case control study in the capital of district of Tambogrande, in December of the 2004. We regarded as housing-case (Hc) to the positive housing for Ae. aegypti infestation, and control housing (Ho) to the negative housing for Ae. aegypti infestation in at least a year with the following criteria, housing once was located in the districtÆs capital, according to the larval control register activities. For each case we considered two controls. We apply to the person in charge of the housingÆs care that we included environmental, social and cultural factors in the questionnaire. Associates factors with p minor than 0,10 value in the univariateanalysis they were included in logistic regression model to estimate them OR adjusted and 95 porcentage confidence intervals (CI). Results: We poll 60 Vc and 124 Vo. The associated factors found in the multiple logistic model they went the presence of bottles in housing (OR: 7,66; CI: 2,95 - 19,84), household located at less than 200 m from a tire deposit (OR: 2,90; CI:1,13 - 7,48), household located at less than 200 m from a wood deposit (OR: 2,76; CI:1,14 - 6,66), and householdswith an inner garden (OR: 2.31; CI: 0,98 - 7,48) were statistically significant. We also identified that a household that has a maid (OR: 0,07; CI: 0,14 - 0,37) was a protective factor. Conclusions: The factors identified should be taken intoaccount in the development of vector control programs in Tambogrande.

Analgesia epidural y resultados obstétricos / Epidural analgesia and obstetric outcomes

Se realizó un estudio retrospectivo, descriptivo y comparativo acerca de los efectos de la analgesia epidural frente a no analgesia epidural en el parto, en una muestra de 1.928 partos acontecidos en un período de 3 años y se atendió a una serie de parámetros que se pueden ver influenciados de manera positiva o negativa, como son factores relacionados con las distintas fases del parto, distocias, instrumentación, índice de cesáreas, repercusiones neonatales e impacto sobre el suelo pélvico. Tras el tratamiento estadístico, se observaron diferencias significativas en la prolongación del parto, el mayor número de instrumentación, el aumento en la tasa de cesáreas y el incremento del índice de episiotomías en multíparas en los partos conducidos bajo analgesia epidural. Por el contrario, no se dieron diferencias significativas en las distocias en occipito posterior, fiebre intraparto, partos con cesárea anterior o episiotomías en primíparas. Hubo significación estadística a favor de los partos sin analgesia epidural en el número de infecciones neonatales, así como desgarros perineales de primer grado en multíparas e integridad perineal en multíparas. A tenor de estos resultados obtenidos en nuestro hospital, nos planteamos incorporar al documento de consentimiento informado sobre analgesia epidural todos los posibles efectos adversos derivados de ésta (AU)

We performed a descriptive retrospective study comparing the effects of the application versus non application of epidural analgesia during delivery in1928 women over a 3-year period. Several parameters that could be positively or negatively influenced by epidural analgesia administration, such as factors related to the different stages of delivery, dystocia, instrumentation, rate of cesarean sections, neonatal repercussion and impact on the pelvic floor, were evaluated. Statistical analysis revealed that epidural analgesia was associated with prolongation of delivery and increases in the number of instruments involved and the rates of cesarean section and episiotomy in multiparas. These differences were statistically significant. In contrast, no significant differences were found in the occurrence of dystocia in the occipito posterior position, intrapartum fever, deliveries with prior cesarian section or episiotomy in primiparas. Statistically significant differences were found in favor of deliveries without epidural analgesia in the number of neonatal infections, as well as in first degree lacerations and perineal integrity in multiparous women In view of the results obtained in our hospital, we are considering adding all the possible adverse effects associated with epidural analgesia to our informed consent document (AU)

Correlación de la analgesia epidural en el aumento de la tasa de cesáreas / Association between epidural analgesia and increased cesarian section rate

Presentamos un estudio cuyo objetivo es definir la incidencia de la analgesia epidural (AE) sobre el índice de cesáreas. Para ello analizamos de manera retrospectiva 1.928 partos y comparamos 2 grupos: los conducidos bajo AE, frente a los partos sin epidural. Introducimos como sesgos las siguientes variables: paridad, cesárea programada, cesárea anterior y cesárea programada más cesárea previa. Al aplicar el análisis estadístico obtenemos diferencias significativas al suprimir el sesgo de cesárea programada, tanto en primíparas (p = 0,02) como en multíparas (p = 0,049); la tasa de cesáreas se incrementa en los partos con epidural (AU)

The aim of this study was to determine the effect of epidural analgesia on the cesarian section rate. To do this, we retrospectively analyzed 1928 deliveries and compared those performed under epidural analgesia with those performed without epidural analgesia. The following variables were considered as possible sources of bias: parity, elective cesarean section, previous caesarean section, and elective cesarean section plus previous caesarean section. When applying the statistical analysis, we obtained significant differences when suppressing the bias of elective cesarean section, both in primiparas (p = 0.02) and in multiparas (p = 0.049); the rate of cesarean section was increased in deliveries performed with epidural analgesia (AU)