Tratamiento quirúrgico de la estenosis uretral membranosa post-traumática / Surgical treatment of post-traumatic distraction posterior urethral strictures

Aproximadamente entre el 4 y el 14% de las fracturas de pelvis producen una lesión uretral posterior. Las fracturas producidas en el contexto de una caída a horcajadas o un gran traumatismo se asocian más frecuentemente a este tipo de lesiones. La reparación abierta como primera intención no constituye una opción de tratamiento en el momento agudo. A los 3-6 meses de haber emplazado un catéter de derivación suprapúbica puede realizarse un intento de reparación programado por segunda intención. Este tiempo, permite la maduración de la cicatriz, la reabsorción del hematoma pélvico y la reestructuración relativa de los planos y fascias. La complejidad de este tipo de intervenciones puede minimizarse siguiendo un correcto protocolo tanto diagnóstico como quirúrgico. La uretroplastia anastomótica bajo los preceptos del abordaje perineal progresivo constituye una magnífica opción de tratamiento para estos pacientes.El objetivo de este trabajo es la descripción detallada de la técnica realizada en nuestro centro para el tratamiento de este tipo de lesiones(AU)

Approximately 4-14% pelvic fractures cause a posterior urethral injury. Pelvic fractures associa-ted with straddle injuries or large trauma accidents are more frequently involved with this kind of lesions. Primary open repair of the urethral injury is discouraged in the acute setting. 3-6 months after urinary diversion a formal open reconstruction can be safely attempted. This gives time for scar maturation, reabsorption of pelvic hematomas, and relative restoration of anatomical fascial layers. The complexity of such interventions can be mini-mized following proper diagnostic and surgical protocols. Anastomotic urethroplasty under the precepts of the progressive perineal approach provides an excellent treatment option for these patients.The aim of this paper is the detailed description of the procedure for the treatment of such injuries(AU)

Protein turnover in patients before and after elective orthopaedic operations

Whole body protein turnover was measured in 11 patients before and after elective orthopaedic operations by giving 15N-glycine orally every 4 hours for 32 hours. The patients were maintained throughout on a constant protein intake. In two control subjects a comparison was made between intermittent dosage and continuous infusion of 15N-glycine for the estimation of total turnover. With intermittent dosage the 15N abundance in urinary urea reached a constant level after about 24 hours. Rates of total protein synthesis and breakdown were calculated from the 15N abundance at the plateau level. After surgery there was a moderate increase in urinary N output. The apparent N balance (intake - urinary N) was -0.25 ñ 1.31 g/d (mean ñ s.d.) before operation and =7.51 ñ 4.5g/d/ after operation. The rate of protein synthesis fell from 3.83 ñ 0.73g kg-1d-1 before operation to 2.94 ñ 0.83 g kg-1d-1 after operation. This difference is statistically significant (0.05 > p > 0.01). There was no significant change in the rate of protein breakdown. The possibility remains that a block in protein synthesis, probably mainly in muscle, may be partly responsible for the so-called 'catabolic' loss of nitrogen after injury, but this has not been proved. (AU)