Bupivacaine Toxicity Increases Transmural Dispersion of Repolarization, Developing of a Brugada-like Pattern and Ventricular Arrhythmias, Which is Reversed by Lipid Emulsion Administration. Study in an Experimental Porcine Model.

Unintentional administration of bupivacaine may be associated with electrocardiogram changes that promote the development cardiac arrhythmias. Ventricular repolarization markers (corrected QT, QT dispersion, Tpeak-Tend and Tpeak-Tend dispersion) are useful to predict cardiac arrhythmias. We aim to investigate the effects of bupivacaine on the transmural dispersion of repolarization and their reversion following intravenous lipid emulsion (ILE) administration. Fourteen pigs were anaesthetized with thiopental and sevoflurane and underwent tracheal intubation. After instrumentation, a 4 mg kg-bolus of bupivacaine was administrated followed by an infusion of 100 µg kg-1 min-1. QT interval, QTc:QT corrected by heart rate, Tpeak-to-Tend interval and QT and Tpeak-to-Tend dispersion were determined in a sequential fashion: after bupivacaine (at 1 min, 5 min and 10 min) and after ILE (1.5 mL kg-1 over 1 min followed by an infusion of 0.25 mL kg-1 min-1). Three additional animals received only ILE (control group). Bupivacaine significantly prolonged QT interval (∆:36%), QT dispersion (∆:68%), Tpeak-to-Tend (∆:163%) and Tpeak-to-Tend dispersion (∆:98%), from baseline to 10 min. Dispersion of repolarization was related to lethal arrhythmias [three events, including asystole, sustained ventricular tachycardia (VT)] and repeated non-sustained VT (4/14, 28%). A Brugada-like-ECG pattern was visualized at V1-4 leads in 5/14 pigs (35%). ILE significantly decreased the alterations induced by bupivacaine, with the termination of VT within 10 min. No ECG changes were observed in control group. Bupivacaine toxicity is associated with an increase of transmural dispersion of repolarization, the occurrence of a Brugada-like pattern and malignant VA. ILE reverses the changes in dispersion of repolarization, favouring the disappearance of the Brugada-like pattern and VT.

Estudio radiológico para evaluar la difusión de dos volúmenes (10 vs. 20ml) de contraste radiopaco en el bloqueo de las ramas cutáneas de los nervios intercostales en la línea medio axilar (BRILMA) en un modelo experimental porcino / Radiological study to evaluate the spreading of two volumes (10 vs. 20ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model

Objetivo: Los bloqueos interfasciales de la pared torácica se están desarrollando como alternativa a los bloqueos centrales en la cirugía de mama. Sin embargo, existen escasos estudios que hayan evaluado la extensión anatómica del anestésico local. Nuestro objetivo fue analizar, mediante fluoroscopia, la difusión de dos volúmenes (10 vs. 20ml) de contraste radiopaco (iopamidol) en el bloqueo del plano serrato-intercostal (BRILMA) en un modelo experimental porcino. Material y métodos: Se seleccionaron 10 cerdos de la raza Large-White a los que se realizó un bloqueo BRILMA ecoguiado bilateral, administrando 10 y 20ml de iopamidol en hemitórax izquierdo y derecho, respectivamente. La difusión del contraste se analizó por fluoroscopia. Se utilizó el test de correlación de Spearman para evaluar la relación entre el volumen administrado y la difusión radiológica. Se consideró significativo un valor de p<0,05. Resultados: Se realizaron 20 bloqueos, pudiéndose analizar 18. La administración de 10ml de contraste se asoció con una difusión media de 2,28±0,31 espacios (IC 95%: 2,01-2,54), mientras que la administración de 20ml mostró una difusión de 3±0,25 espacios (IC 95%: 2,81-3,18). Hubo una correlación significativa entre el volumen inyectado y la difusión del contraste (coeficiente de correlación de Spearman de 0,81; p=0,0001). Conclusión: Nuestros resultados demuestran una difusión dependiente del volumen en el bloqueo BRILMA, aunque sin guardar una relación 1:1. Duplicar el volumen ha incrementado en un 31% los segmentos bloqueados. Estos hallazgos, si se corroboran en la práctica clínica, permitirían un ajuste más preciso en el volumen de anestésico administrado

Objective: Interfascial blocks of the thoracic wall are being developed as an alternative to central blocks in breast surgery. However, there are few studies that have evaluated the anatomical extension of the local anaesthetic. The objective of this study was to analyse, using fluoroscopy, the spreading of two volumes (10 vs. 20ml) of radiological contrast in the serratus-intercostal plane block in an experimental pig model. Material: and methods Ten Large-White breed pigs were selected to have a bilateral ultrasound serratus-intercostal plane block performed, with the administering of 10ml and 20ml of iopamidol in the right and left hemithorax, respectively. The spreading of contrast was analysed by fluoroscopy. The Spearman test correlation was used to evaluate the relationship between the administered volume and radiological spreading. A value of P<.05 was considered significant. Results: Twenty anaesthetic blocks were performed, being able to analyse 18 of them. The administration of 10ml of contrast was associated with a mean spreading of 2.28±0.31 (95% CI; 2.01-2.54) intercostal spaces, while the administration of 20ml showed a spreading of 3±0.25 (95% CI; 2.81-3.18) intercostal spaces. There was a significant correlation between the injected volume and the spreading of the contrast (Spearman correlation coefficient of 0.81; P=.0001). Conclusion: The results showed a spreading of volume subject to the serratus-intercostal plane block, although not maintaining a 1:1 ratio. Doubling the volume increased the blocked segments by 31%. These findings, if corroborated in the clinical practice, would allow a more precise adjustment in the anaesthetic volume administered

Radiological study to evaluate the spreading of two volumes (10 vs. 20ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model. / Estudio radiológico para evaluar la difusión de dos volúmenes (10 vs. 20ml) de contraste radiopaco en el bloqueo de las ramas cutáneas de los nervios intercostales en la línea medio axilar (BRILMA) en un modelo experimental porcino.

OBJECTIVE: Interfascial blocks of the thoracic wall are being developed as an alternative to central blocks in breast surgery. However, there are few studies that have evaluated the anatomical extension of the local anaesthetic. The objective of this study was to analyse, using fluoroscopy, the spreading of two volumes (10 vs. 20ml) of radiological contrast in the serratus-intercostal plane block in an experimental pig model. MATERIAL AND METHODS: Ten Large-White breed pigs were selected to have a bilateral ultrasound serratus-intercostal plane block performed, with the administering of 10ml and 20ml of iopamidol in the right and left hemithorax, respectively. The spreading of contrast was analysed by fluoroscopy. The Spearman test correlation was used to evaluate the relationship between the administered volume and radiological spreading. A value of P<.05 was considered significant. RESULTS: Twenty anaesthetic blocks were performed, being able to analyse 18 of them. The administration of 10ml of contrast was associated with a mean spreading of 2.28±0.31 (95% CI; 2.01-2.54) intercostal spaces, while the administration of 20ml showed a spreading of 3±0.25 (95% CI; 2.81-3.18) intercostal spaces. There was a significant correlation between the injected volume and the spreading of the contrast (Spearman correlation coefficient of 0.81; P=.0001). CONCLUSION: The results showed a spreading of volume subject to the serratus-intercostal plane block, although not maintaining a 1:1 ratio. Doubling the volume increased the blocked segments by 31%. These findings, if corroborated in the clinical practice, would allow a more precise adjustment in the anaesthetic volume administered.

Desarrollo de un modelo experimental para el estudio de la toxicidad cardiaca inducida por bupivacaína, implicaciones para la anestesia en Cirugía Ambulatoria / Development of an experimental model for the study of bupivacaine induced cardiotoxicity, implications for anesthesia in Ambulatory Surger

Objetivo: Recientemente existe un renovado interés por las técnicas locorregionales, asistiendo a una gran demanda tanto por los pacientes como por los equipos quirúrgicos, especialmente en la cirugía ambulatoria. La descripción de casos clínicos graves asociados a intoxicación por bupivacaína es un evento infrecuente, sin embargo, para mejorar nuestro conocimiento y prevenir la toxicidad de los anestésicos locales es necesario el desarrollo de modelos animales. Los efectos adversos cursan con alteraciones electrocardiográficas relacionadas especialmente con la conducción ventricular y con prolongación del intervalo QRS. Poder detectar una intoxicación grave por anestésicos locales antes de que ocurra un colapso cardiovascular tendría importantes consideraciones clínicas. Nuestro objetivo fue desarrollar un modelo no letal de intoxicación aguda por bupivacaína y correlacionar los niveles del fármaco con el complejo QRS como marcador instantáneo de una intoxicación grave por anestésicos locales. Material y métodos: Se estudiaron 8 cerdos large-White premedicados con ketamina, 20 mg/kg, y anestesiados con tiopental sódico (19 ± 8 mg/kg-1) como inductor y sevoflurano 1 CAM (2,6 %) para el mantenimiento anestésico. Se canalizaron la arteria y vena femoral para la monitorización invasiva, determinaciones analíticas y de niveles de bupivacaína. Al finalizar la instrumentalización, se administró bupivacaína en dosis de 4 mg/kg-1. Se realizaron determinaciones analíticas antes y al 1, 5, 10 y 30 minutos de administración del fármaco. Se evaluó la correlación entre los niveles de bupivacaína en sangre y el intervalo QRS. Se consideró significativo una p < 0,05. Análisis estadístico: Test de correlación de Spearman. Resultados: Ningún animal falleció como resultado de la experiencia. El porcentaje medio de aumento del QRS fue de 185 ± 60 ms. Hubo una correlación estadísticamente significativa entre la duración del intervalo QRS y los niveles plasmáticos de bupivacaína, coeficiente de correlación de Spearman: 0,80; p < 0,0001. Conclusión: Nuestro modelo ha permitido el estudio de uno de los aspectos más relevantes de toxicidad de la bupivacaína. El ensanchamiento del intervalo QRS se ha relacionado positivamente con los niveles de bupivacaína. La modificación instantánea de este parámetro puede ser un marcador clínico instantáneo de gran utilidad en la práctica clínica diaria

Objective: Recently there has been an extraordinary advance in the techniques of regional anaesthesia, assisting to a great demand from the patients and the surgical team especially in day surgery. Reports of serious cardiac bupivacaine intoxication are fortunately unusual, however in order to improve our knowledge and prevention of local anaesthetic toxicity the development of animal models is needed. The adverse event comes along with important electrocardiographic alterations, especially those related to ventricular conduction such as the QRS interval widening. Detecting a severe intoxication with local anaesthetic before a cardiovascular collapse takes place involves important clinical considerations. We aimed to develop a non-lethal steady model of bupivacaine intoxication and correlate bupivacaine plasma levels with the QRS complex duration as an instantaneous marker of severe local anaesthetic intoxication. Material and methods: Eight mini-pigs were premedicated with ketamine and anesthetized with intravenous sodium thiopental 5 mg/kg. The anesthetic maintenance was performed with sevoflurane 1 CAM (2.6 %). Femoral artery and vein were canalized for invasive monitoring, analytical blood gas samples and bupivacaine levels determinations. After instrumentation and motorization, a bupivacaine bolus of 4 mg/kg-1 was administered. Electrocardiographic parameters were recorded and blood samples were taken before and 1, 5, 10 and 30 min after the drug administration. We correlated venous plasma concentration with the QRS widening observed. Statistical: Spearman rank correlation coefficient. A P-value < 0.05 was considered statistically significant. Results: No animal died as a result of the experience and hemodynamic data and blood gas analysis were maintained at physiological range. The mean maximal percent increase in QRS interval was 185 ± 60 ms. There was a statistically significant positive correlation between the QRS interval and bupivacaine plasmatic levels. (Correlation coefficient of r = 0,80 (p < 0,0001). Conclusions: This porcine model of bupivacaine intoxication has been steady, obtaining important electrocardiographic modifications and keeping alive all animals. The relevant QRS interval widening was positively correlated with bupivacaine plasmatic levels. The instantaneous modification of this electrocardiographic parameter could be a useful clinical marker of serious bupivacaine intoxication in a daily basis

Análisis de la regresión temporal en el ensanchamiento del intervalo QRS inducido por bupivacaína con la administración de Intralipid. Estudio en un modelo experimental porcino / Analysis of the temporal regression of the QRS widening induced by bupivacaine after Intralipid administration. Study in an experimental porcine model

Objetivo: La toxicidad cardiaca inducida por la bupivacaína (B) se relaciona con el bloqueo de los canales de sodio, que se traduce por un ensanchamiento del intervalo QRS. Estudios experimentales recientes, sugieren que el Intralipid (IL) es eficaz en revertir la toxicidad cardiaca de la B. Nuestro objetivo fue analizar la evolución temporal del ensanchamiento del QRS inducido por la B con la administración de IL. Material y método: Doce cerdos fueron anestesiados con tiopental sódico, 5 mg kg−1, y sevoflurano a concentración alveolar mínima de 2,6%. Tras la instrumentalización se administró un bolo de B de 4-6 mg kg−1 con el objetivo de inducir un aumento de 150% en la duración del QRS. El grupo IL recibió 1,5 mL kg−1 de IL seguido de 0,25 mL kg min−1; el grupo control (C) recibió salino. Se registraron los parámetros electrocardiográficos tras la infusión de B y a 1, 5,10 y 30 min de la administración de Intralipid/salino. Resultados: La administración de B (4,33°æ 0,81 mg/kg en el grupo IL y 4,66°æ 1,15 mg/kg en el grupo C) indujo cambios electrocardiográficos similares en ambos grupos; el porcentaje medio de incremento máximo en el QRS fue de 184°æ 62% en el grupo IL, y de 230°æ 56% en el grupo C. El IL revirtió el ensanchamiento del QRS inducido por la B, a los 10 min de su administración el intervalo QRS disminuyó 132°æ 56% vs. 15°æ 76%, en relación al máximo incremento inducido por la B, en el grupo IL y grupo C respectivamente. Conclusión: El IL revirtió eficazmente el ensanchamiento del intervalo QRS inducido por la B. El tiempo hasta la normalización de los parámetros electrocardiográficos puede prolongarse más de 10 min. Mientras persistan los fenómenos de toxicidad cardíaca, las medidas de resucitación y monitorización deben continuarse hasta que los parámetros de conducción cardíaca se hayan restaurado de forma adecuada (AU)

Objective: The principal mechanism of cardiac toxicity of bupivacaine relates to the blockade of myocardial sodium channels, which leads to an increase in the QRS duration. Recently, experimental studies suggest that lipid emulsion is effective in reversing bupivacaine cardiac toxicity. We aimed to evaluate the temporal evolution of the QRS widening induced by bupivacaine with the administration of Intralipid. Material and methods: Twelve pigs were anesthetized with intravenous sodium thiopental 5 mg kg−1 and sevoflurane 1 MAC (2.6%). Femoral artery and vein were canalized for invasive monitoring, analysis of blood gases and determination of bupivacaine levels. After instrumentation and monitoring, a bupivacaine bolus of 4-6 mg kg−1 was administered in order to induce a 150% increase in QRS duration (defined as the toxic point). The pigs were randomized into two groups of six individuals. Intralipid group (IL) received 1.5 mL kg−1of IL over one minute, followed by an infusion of 0.25 mL kg min−1. Control group (C) received the same volume of a saline solution. The electrocardiographic parameters were recorded, and blood samples were taken after bupivacaine and 1, 5, 10 and 30 minutes after Intralipid/saline administration. Results: Bupivacaine (4.33°æ 0.81 mg/kg in IL group and 4.66°æ 1.15 mg/kg in C group) induced similar electrocardiographic changes in both groups; mean maximal percent increase in QRS interval was 184°æ 62% in IL group, and 230°æ 56% in control group (NS). Lipid administration reversed the QRS widening previously impaired by bupivacaine. After ten minutes of the administration of IL, the mean QRS interval decreased to 132°æ 56% vs. 15°æ 76% relative to the maximum widening induced by bupivacaine, in IL and C group, respectively. Conclusion: Intralipid reversed the lengthening of QRS interval induced by the injection of bupivacaine. Time to normalization of electrocardiographic parameters can last more than 10 minutes. While the phenomena of cardiac toxicity persist, resuscitation measures and adequate monitoring should be continued until adequate heart conduction parameters are restored (AU)

Lung cancer and other second neoplasms after treatment of Hodgkin lymphoma

Purpose. To evaluate the risk factors associated with lung cancer (LC) and other second neoplasms (SN) in Hodgkin lymphoma (HL) survivors. Methods. We retrospectively analyzed the clinical characteristics and outcomes of 604 patients treated in our institution between 1968 and 2012. Results. 90 out of 604 patients developed SN: 27 LC and 63 other SN. The median time elapsed until LC and other SN was 16.5 and 11.8 years, respectively (p = 0.003). In the LC group, 85.5 % of patients were male and 84.6 % smokers (HR 7, 95 % CI 2.4-20.7, p < 0.001). Radiotherapy (RT) doses applied were higher in the SN group with an increased risk of LC (HR: 4.0 95 % CI 1.1-11.6, p = 0.010) and other SN (HR: 3.3 95 % CI 1.6-6.7 p = 0.001) with doses higher than 42 Gy. No association was found between alkylating agents and development of SN. In LC, the most frequent histology was adenocarcinoma with an elapsed time after HL of 13.2 years in early stages and 21.3 in advanced (p = 0.02). Median OS after a diagnosis of LC was 12.6 months ranging from 5.9 (in cases presenting due to symptoms) to 49.1 (incidentally diagnosed cases) (p = 0.005). Conclusions. RT treatment, especially with doses higher than 42 Gy, and smoking increase the risk of SN after HL. In this series, LC patients with early stages had a shorter elapsed time from HL diagnosis and longer OS, therefore the role of LC screening in HL survivors should be prospectively evaluated and smoking cessation counseling ought to be a key aspect during follow-up (AU)

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Lung cancer and other second neoplasms after treatment of Hodgkin lymphoma.

PURPOSE: To evaluate the risk factors associated with lung cancer (LC) and other second neoplasms (SN) in Hodgkin lymphoma (HL) survivors. METHODS: We retrospectively analyzed the clinical characteristics and outcomes of 604 patients treated in our institution between 1968 and 2012. RESULTS: 90 out of 604 patients developed SN: 27 LC and 63 other SN. The median time elapsed until LC and other SN was 16.5 and 11.8 years, respectively (p = 0.003). In the LC group, 85.5 % of patients were male and 84.6 % smokers (HR 7, 95 % CI 2.4-20.7, p < 0.001). Radiotherapy (RT) doses applied were higher in the SN group with an increased risk of LC (HR: 4.0 95 % CI 1.1-11.6, p = 0.010) and other SN (HR: 3.3 95 % CI 1.6-6.7 p = 0.001) with doses higher than 42 Gy. No association was found between alkylating agents and development of SN. In LC, the most frequent histology was adenocarcinoma with an elapsed time after HL of 13.2 years in early stages and 21.3 in advanced (p = 0.02). Median OS after a diagnosis of LC was 12.6 months ranging from 5.9 (in cases presenting due to symptoms) to 49.1 (incidentally diagnosed cases) (p = 0.005). CONCLUSIONS: RT treatment, especially with doses higher than 42 Gy, and smoking increase the risk of SN after HL. In this series, LC patients with early stages had a shorter elapsed time from HL diagnosis and longer OS, therefore the role of LC screening in HL survivors should be prospectively evaluated and smoking cessation counseling ought to be a key aspect during follow-up.

Analysis of the temporal regression of the QRS widening induced by bupivacaine after Intralipid administration. Study in an experimental porcine model.

OBJECTIVE: The principal mechanism of cardiac toxicity of bupivacaine relates to the blockade of myocardial sodium channels, which leads to an increase in the QRS duration. Recently, experimental studies suggest that lipid emulsion is effective in reversing bupivacaine cardiac toxicity. We aimed to evaluate the temporal evolution of the QRS widening induced by bupivacaine with the administration of Intralipid. MATERIAL AND METHODS: Twelve pigs were anesthetized with intravenous sodium thiopental 5mg kg(-1) and sevoflurane 1 MAC (2.6%). Femoral artery and vein were canalized for invasive monitoring, analysis of blood gases and determination of bupivacaine levels. After instrumentation and monitoring, a bupivacaine bolus of 4-6 mg kg(-1) was administered in order to induce a 150% increase in QRS duration (defined as the toxic point). The pigs were randomized into two groups of six individuals. Intralipid group (IL) received 1.5 mL kg(-1)of IL over one minute, followed by an infusion of 0.25 mL kg min(-1). Control group (C) received the same volume of a saline solution. The electrocardiographic parameters were recorded, and blood samples were taken after bupivacaine and 1, 5, 10 and 30 minutes after Intralipid/saline administration. RESULTS: Bupivacaine (4.33±0.81 mg/kg in IL group and 4.66±1.15 mg/kg in C group) induced similar electrocardiographic changes in both groups; mean maximal percent increase in QRS interval was 184±62% in IL group, and 230±56% in control group (NS). Lipid administration reversed the QRS widening previously impaired by bupivacaine. After ten minutes of the administration of IL, the mean QRS interval decreased to 132±56% vs. 15±76% relative to the maximum widening induced by bupivacaine, in IL and C group, respectively. CONCLUSION: Intralipid reversed the lengthening of QRS interval induced by the injection of bupivacaine. Time to normalization of electrocardiographic parameters can last more than 10 minutes. While the phenomena of cardiac toxicity persist, resuscitation measures and adequate monitoring should be continued until adequate heart conduction parameters are restored.

Action and resistance of monoclonal CD20 antibodies therapy in B-cell Non-Hodgkin Lymphomas.

Anti-CD20 monoclonal antibodies (mAbs) have improved patient's survival with Non-Hodgkin Lymphoma, when combined with chemotherapy. Several mechanisms of action have been reported, including antibody-dependent cellular cytotoxicity, complement-dependent cytotoxicity and induction of apoptosis. Despite the large amount of studies and published data, the role each mechanism played in vivo is not fully understood. Furthermore, the reason why a significant percentage of patients are refractory or resistant remains unknown. Several activated intracellular signaling pathways have been implicated in the mechanisms of resistance of rituximab. In the present manuscript, we review those mechanisms and new anti-CD20 mAbs, as well as the efforts being accomplished to overcome it, focusing on new drugs targeting pathways implicated in resistance to rituximab.

Estudio de calidad de vida en pacientes con hiperplasia benigna de próstata en tratamiento con silodisina / Study of Quality of life in Patients with Benign Prostatic Hyperplasia under Treatment with Silodosin

Objetivos: Evaluar el impacto de los síntomas urinarios asociados a hiperplasia benigna de próstata y su tratamiento con silodosina sobre la calidad de vida (CV) y la función sexual, en función de la edad, la gravedad de los síntomas, el tiempo en tratamiento y el tamaño prostático. Material y métodos: Estudio transversal, observacional, realizado en 305 consultas de urología de España. Se recogieron datos sociodemográficos y clínicos y los pacientes cumplimentaron los cuestionarios EQ-5D, Sexual Function Index (SFI) e International Prostate Symptom Score (IPSS). Se determinaron los factores asociados independientemente a la CV de los pacientes mediante análisis de regresión múltiple. Resultados: Se seleccionaron 1.019 pacientes con media (DE) para: edad 62,7 (5,7) años, puntuación EQ-5D 89,9(13,9), deseo-SFI 3,71 (1,67), erección-SFI 6,11 (3,08), eyaculación-SFI 4,50 (2,06), problemas-SFI 6,85 (3,37), satisfacción sexual-SFI 2,00 (0,99) y mediana IPSS 16 (RI 12-20). Las puntuaciones EQ-5D y SFI fueron inferiores a mayor edad, mayor gravedad de STUI y mayor tamaño prostático (p < 0,01), pero no se encontraron diferencias en cuanto al tiempo en tratamiento con silodosina. En el análisis de regresión múltiple se observó que la puntuación del cuestionario EQ-5D se asoció de forma positiva con las dimensiones satisfacción sexual y deseo del SFI y con la puntuación EVA EQ-5D, y de forma negativa con incapacidad laboral, residencia semi-urbana y comorbilidades. Conclusiones: El deterioro en la función sexual y en la calidad de vida es mayor en los pacientes de mayor edad y en aquellos con STUI graves. Sin embargo, el tratamiento prolongado con silodosina no produce deterioro en la calidad de vida

Objectives: To assess the impact of urinary symptoms associated with benign prostatic hyperplasia and its treatment with silodosin on quality of life (QoL) and sexual function, depending on age, severity of symptoms, time on treatment and prostate size. Material and methods: A cross-sectional, observational study was conducted in 305 urology practices throughout Spain. Socio-demographic and clinical data were collected and patients filled the following questionnaires: EQ-5D, Sexual Function Index (SFI) and International Prostate Symptom Score (IPSS). Multiple regression models were used to determine factors independently associated with patients’ QoL. Results: A total of 1019 patients were enrolled; mean (SD) for: age 62.7 (5.7), EQ-5D 89.9 (13.9), sexual drive-SFI 3.71 (1.67), erection-SFI 6.11 (3.08), ejaculation-SFI 4.50 (2.06), problems-SFI 6.85 (3.37) and overall satisfaction-SFI 2.00 (0.99). The EQ-5D and SFI score were statistically lower with older age, severe LUTS and greater prostate size (P < 0.01), but no differences were found related to time on treatment with silodosin. The EQ-5D score was positively associated with sexual satisfaction and desire size of SFI and the EQ-5D VAS score, and negatively with disability, semi-urban residence and comorbidities in the multiple regression analyses. Conclusions: Severe LUTS and older age are associated to a greater deterioration in sexual function and quality of life. However time on treatment with silodosin does not produce deterioration in the quality of life

Study of quality of life in patients with benign prostatic hyperplasia under treatment with silodosin.

OBJECTIVES: To assess the impact of urinary symptoms associated with benign prostatic hyperplasia and its treatment with silodosin, on quality of life (QoL) and sexual function, depending on age, severity of symptoms, time on treatment and prostate size. MATERIAL AND METHODS: A cross-sectional, observational study was conducted in 305 urology practices all around Spain. Socio-demographic and clinical data were collected and patients filled the following questionnaires: EQ-5D, Sexual Function Index (SFI) and International Prostate Symptom Score (IPSS). Multiple regression models were used to determine factors independently associated with patients' QoL. RESULTS: A total of 1,019 patients were enrolled, mean (SD) for: age 62.7 (5.7), EQ-5D 89.9 (13.9), sexual drive-SFI 3.71 (1.67), erection-SFI 6.11 (3.08), ejaculation-SFI 4.50 (2.06) problems-SFI 6.85 (3.37) and overall satisfaction-SFI 2.00 (0.99). The EQ-5D and SFI score were statistically lower with: older age, severe LUTS and greater prostate size (P<.01), but no differences were found related to time on treatment with silodosin. The EQ-5D score was positively associated with sexual satisfaction and desire size of SFI and the EQ-5D VAS score, and negatively with disability, semi-urban residence and comorbidities in the multiple regression analyses. CONCLUSIONS: Severe LUTS and older age are associated to a greater deterioration in sexual function and quality of life. However time on treatment with silodosin does not produce deterioration in the quality of life.

Efficiency and outcomes of harmonic device in transanal endoscopic microsurgery compared with monopolar scalpel.

INTRODUCTION: An important fact when facing new technologies is their cost for the Health Publishes. The purpose of this paper is to compare the costs of performing TEM with harmonic scalpel and classic monopolar scalpel and to analyze complications. METHODS: Operation time, blood loss, and hospital stay were recorded to determine the cost of the TEM procedure. We also recorded early and late complications. Patients were divided in two groups: harmonic scalpel group (UC) and monopolar scalpel group (MS). RESULTS: TEM for curative intention was used in 330 rectal tumors from January 1997 to January 2010. A total of 229 patients met the criteria for this study: UC group (n = 87) and MS group (n = 142). Patients from the UC group developed fewer complications (16%) than patients from the MS group (23%). The difference of mean stay between groups was 1.5 days (95% confidence interval, 0.7; 2.2 days; P < 0.001) in favor of the UC group. CONCLUSIONS: Harmonic scalpel provides a safer, easier, and more precise surgical section through clean, bloodless, and better visualized operative field. The additional cost of UC was compensated with the decrease in the health resources (mainly hospital stay).

Effectiveness, safety, and cost-effectiveness of photodynamic therapy in Barrett's esophagus: a systematic review.

Barrett's esophagus, the management of which remains controversial, is the precursor condition to esophageal adenocarcinoma. A number of endoscopic treatments have been designed as an alternative to surgical resection for patients with high-grade dysplasia. One of these, photodynamic therapy, involves the light activation of a photosensitizer that causes local tissue destruction via oxidation reactions. The present work reviews the effectiveness, safety, and cost-effectiveness of this treatment. A systematic review of the literature recorded in the Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database, and the National Health Service Economic Evaluation Database was undertaken. Articles reporting randomized clinical trials of photodynamic therapy for the treatment of Barrett's esophagus, and economic assessments of the procedure, were selected. The quality of the articles was checked. Twelve articles were included in this review: eight randomized, controlled clinical trials and four economic assessments. The clinical trials suffered from methodological limitations, but the economic assessments were considered to be good quality. Photodynamic therapy is effective for the ablation of dysplasia in Barrett's esophagus, although the frequency of adverse events is quite high. The procedure is presented as a cost-effective alternative to intense endoscopic monitoring and esophagectomy. However, the evidence regarding its effectiveness in reducing the number of patients who go on to develop cancer is only incipient. Rigorous, controlled studies with longer follow-up times, in which photodynamic therapy is compared with surgical resection and other endoscopic techniques, are needed.