Dynamic field testing of coating chemistry candidates by a rotating disk system.

Quick and reliable testing is crucial for the development of new fouling release (FR) coatings. Exposure of these coatings to natural multispecies communities is essential in evaluating their efficacy. To this end, we present a rotating disk setup for dynamic field exposure. To achieve a well-defined flow on the surface of the disk, an easy to use sample mounting system was developed that provides a smooth and even surface. We related the angular velocity of the disk to the wall shear stress on the surface with a hydrodynamic model. The wall shear stress was adjusted to values previously found to be suitable to discriminate dynamic diatom attachment on different coating chemistries in the lab. The effect of the dynamic conditions was shown by comparing polystyrene slides under static and dynamic exposure. Using a set of self-assembled monolayers, the discrimination potential of the assay in a multispecies environment was demonstrated.

Autoevaluación de un proceso asistencial (colecistectomía laparoscópica) / Self-evaluation of a health care process: laparoscopic cholecystectomy

Introducción. Presentamos una forma de evaluar la asistencia clínica, establecimiento de una "ruta crítica" de un proceso asistencial "trazador". Pacientes y método. Se han estudiado 423 pacientes colecistectomizados por vía laparoscópica en 69 meses, de los cuales el 16 por ciento presentaba litiasis coledocal y el 30 por ciento colecistitis agudas. Los datos fueron recogidos de la historia clínica, del servicio de codificación del hospital y del propio INSALUD, así como de las respuestas remitidas a una encuesta enviada después del alta al paciente. Resultados. La colecistectomía se pudo realizar por vía laparoscópica en el 90 por ciento de los pacientes, la colangiopancreatografía retrógrada endoscópica fue efectiva en el 90 por ciento de coledocolitiasis, con valor predictivo positivo del 62,2 por ciento, las tasas de morbilidad laparoscópica fueron del 10 por ciento, y mortalidad del 1,4 por ciento. El índice de reingresos fue del 4,7 por ciento, y la estancia global de 6,1 días. El tiempo en lista de espera de 50 días. El grupo de diagnóstico relacionado (GDR) (494) supuso un coste de 238.874 ptas. La baja laboral ha tenido una media de 54,62 días. El consentimiento informado constaba en la historia del 67,7 por ciento de los pacientes, el informe de alta médica en el 94,6 por ciento y el informe anatomopatológico en el 100 por ciento. La puntuación media de la satisfacción fue superior al 80 por ciento. Conclusiones. Debemos mejorar algunos aspectos de la recogida de datos del servicio de información. La calidad global asistencial es alta y estamos en disposición de iniciar la colecistectomía como cirugía mayor ambulatoria. Los costes directos hospitalarios se encuentran por debajo de la media de los hospitales de sus características, aunque no así los costes indirectos (invalidez laboral transitoria). La satisfacción del paciente es muy alta (AU)

[Wünderlich syndrome caused by metastatic gastric sarcoma in the kidney. Report of a case]. / Síndrome de Wünderlich por metástasis de sarcoma gástrico en riñón. Aportación de un caso.

Contribution of one case of Wünderlich Syndrome secondary to a simple metastasis to the right kidney from a gastric sarcoma operated three years earlier. Pain, palpable mass on the side and decreased haematocrit were the primary symptoms. Diagnosis was confirmed by Computerized Axial Tomography. The therapeutical approach was radical nephrectomy. At 5 years, this female patient remains alive showing no evidence of tumoral disease in the follow-up controls performed.

[PSA and hormone-refractory period in prostatic cancer]. / PSA y periodo hormonorrefractario del cáncer de próstata.

Study of the characteristics of the hormone-refractory period in 32 patients with disseminated prostate cancer who had achieved a complete response to total androgen suppression, appreciating in all of them a subclinical or asymptomatic stage and a clinical or symptomatic one. The subclinical stage was characterized by raised PSA levels and ranged between 3-35 months; at 12 months 59% of patients had advanced to the symptomatic stage, while at 24 months this percentage is 84%. The clinical stage extends from appearance of symptoms to the patient's death, ranging from 3 to 32 months; at 12 months 41% has died; and 91% at 2 years.

[Polypoid cystitis mimicking bladder tumor]. / Cistitis polipoide simulando un tumor de vejiga.

Presentation of one case of polypoid cystitis in a 38 year-old male, with no urological history. The form of clinic presentation and the endoscopic exploration induced to suspect the existence of a bladder tumour. Diagnosis was confirmed by the result of the histopathological study of the piece.

[Toxicity of prophylaxis of superficial bladder tumors]. / La toxicidad en la profilaxis de los tumores superficiales de vejiga.

The paper reviews the various prophylaxis modalities in surface vesical tumours in order to define the degree of toxicity caused by each of them. Also, a prophylaxis diagram is prepared, having into account each substance's toxicity, the benefit awarded to each of then and the tumour prognosis. The agents under assessment are Thiotepa, Adriamycin, Epirubicin, Cisplatin, oral Methotrexate, Mitomycin-C, Mitoxantrone, Interferon and BCG, at doses of 40, 120 and 150 mg. Two groups of prophylactic agents can be identified with regard to toxicity. The first one is constituted by Interferon, Adriamycin, Epirubicin and Mitomycin-C, with side-effects lower than or close to the net benefit estimated for each. The second group comprises cytostatic and immunomodulatory compounds with toxic effects greater than their net benefit. In this group, three different situations can be distinguished: a) BCG with high toxicity and high net benefit; b) Cisplatin, Thiotepa and Mitoxantrone with high toxicity and net benefit similar to that of Adriamycin, Epirubicin and Mitomycin C; and c) Oral Methotrexate, with high toxicity and no benefit. According to their toxicity levels, Interferon, Adriamycin, Epirubicin and Mitomycin C are indicated in the prophylaxis of medium-risk tumours, while BCG only in high-risk tumours. Thiotepa, Cisplatin, Mitoxantrone and oral Methotrexate have to be eliminated due to their negative benefit-toxicity relationship.

[Controversies and progress in the diagnosis and treatment of benign prostatic hypertrophy. Personal experience]. / Controversias y avances en el diagnóstico y tratamiento de la hipertrofia prostática benigna. Experiencia personal.

Historically, non surgical procedures awakened little interest among urologists because surgery represented a definite solution with acceptable morbidity and mortality rates. Currently, the diagnosis and management of BPH is pointed towards a greater understanding of those prostate conditions with a trend to obstruction, using more refined methods to assess the severity of the obstruction, identification of predictive parameters of the therapeutical response, and evaluation of the various treatment alternatives based on safety and cost-efficiency parameters.

[Acute scrotum as clinical presentation form of testicular tumor]. / Escroto agudo como forma de presentación clínica de un tumor de testículo.

Testis tumours usually emerge in young patients as a painless increase in the testis size accidentally noticed by the patient. Contribution of one case of non-seminomatous testis tumour which presented clinically as an acute scrotum. An exhaustive appraisal of the clinical data allowed to choose the most appropriate approach for the patient in an emergency situation.

[Inverted papilloma of the urethra]. / Papiloma invertido de uretra.

The inverted papilloma of the urethra is an exceptional entity. It occurs as a smooth surface, sessile tumour located in the prostatic urethra. Microscopically, it is lined with transitional epithelium which is projected inside the tumour, creating strands of cells with normal characteristics. All cases reported up to now have occurred in men aged between 49 and 79. None of the cases had additional urothelial injuries associated. Contribution of a new case of inverted papilloma of the prostatic urethra in a 52-year old male. Transurethral resection of the tumour was the procedure chosen. Evolution was good and no relapse nor further urothelial injuries were observed at the controls carried out over an 8-year follow-up period.

[Renal leiomyosarcoma]. / Leiomiosarcoma renal.

Presentation of one case of a large, rapidly growing and highly aggressive renal leiomyosarcoma. The diagnostic and therapeutical possibilities of this infrequent tumour are analyzed.

[Congenital cysts of the choledochus]. / Quistes congénitos del colédoco.

We describe six cases of congenital choledochal cyst of the Toddani type I. All were female, with a mean age of 33.5 years (16-52). The onset of symptoms ranged 8-192 months (mean 92.8), with an unexpected finding. Ultrasound scan was performed in five patients, with two accurate diagnoses, one suspicious and two wrong results. In two cases a C.T. was performed and the diagnosis was confirmed in both. A cholelithiasis was associated in four cases. Four patients (66.4%) were treated by cyst excision, Roux-en-Y hepaticojejunostomy and cholecystectomy, three of them as a primary procedure, and one more after failure of some derivative operations. All evolved well but one, requiring sphincterotomy and Wirsungtomy. Two patients (33.6%) were treated by cholecystectomy only, with a favourable evolution. Nevertheless, we emphasize the good results achieved with cyst excision and we recommend it as the procedure of choice.

[Results of treatment with interferon and vinblastine in renal cancer]. / Resultados del tratamiento con interferón y vinblastina en el cáncer de riñón.

Contribution of our experience with Alpha-2a Interferon and Vinblastine, for the treatment of advanced renal cancer in patients formerly not treated with nephrectomy. Pathoanatomical diagnosis was confirmed by puncture biopsy. None of the 4 patients recruited in the protocol showed objective response. In 2 patients no change was observed and in the other 2 the disease progressed. In surviving patients it was impossible to sustain therapy for more than three months. Treatment was discontinued as a result of the Interferon side-effects, such as fever, myalgia, asthenia and neuritis.

[Non-chromaffin non-functioning aortosympathetic paraganglioma]. / Paraganglioma aortosimpático nocromafín afuncionante.

The paraganglia system is the largest component in the construction of the Disseminated Neuroendocrine System, comprising cells derived from the neural crest, with ability to synthesize and secrete catecholamines, hormones and peptides. A general explanation on the subject with a personal contribution is made.

[Prospective studies for determining the duration of prevention in superficial tumors of the bladder]. / Estudio prospectivo para determinar la duracion de la profilaxis en los tumores superficiales de vejiga.

The study covers a series of 221 patients with pTa or pT1 vesical tumours who were treated by RTU and had an endovesical cytostatic agent instilled prophylactically for a year. Before beginning the tumour resection, biopsies in map with cold forceps were routinely taken from the trigone, side walls, bottom walls and vesical cup. It was decided to monitor the patients by performing cystoscopies and biopsies in map with cold forceps every quarter. During the second and third year the endoscopic and bioptic monitoring was done every six months. During the time when the cytostatic agents were instilled, a significant decrease (p less than 0.01) in the percentage of patients with 'CIS' was observed. After discontinuing the instillation, the percentage of patients with 'CIS' reversed to similar figures as seen prior to the study. It can be deduced from this observation that prophylaxis can be effective against those elements of the urothelial disease which influence the arrival of new events and the increase of the tumoral stage, and that the control of those factors disappears when the prophylaxis is discontinued. The study illustrates that prophylaxis in the urothelial disease should be maintained indefinitely.

Bilateral abscessed orchiepididymitis associated with sepsis caused by Veillonella parvula and Clostridium perfringens: case report and review of the literature.

Veillonella species is a gram-negative coccus which is part of the anaerobic normal flora in the oral cavity, small intestine, upper respiratory tract, vagina, and urinary tract. The role that this organism plays in infection is not well known, and it is generally associated with other bacteria. We present a case of bilateral abscessed orchiepididymitis associated with septicemia due to Veillonella parvula and, later, to Clostridium perfringens, with the development of severe renal insufficiency and septic shock, which resolved favorably with antibiotic therapy, treatment of shock, and hyperbaric oxygen therapy. In reviewing the literature, we have not found any other case of sepsis due to Veillonella sp. associated with urological disorders.