Physiopathology of the Priapism Secondary to Tamsulosin: Clinical Cases of Our Hospital and Literature Review

Objective: To describe two cases of man with the diagnosis of ischemic priapism after the intake of tamsulosin and to revise the scientific literature. Methods: We present two cases of men that developed an ischemic priapism after the intake of tamsulosin prescribed for STUI and were treated in our hospital. We described the two cases, from the diagnosis until the surgery that was performed. Also, we review the scientific literature about this topic. Results: In one hand, a 67 years old man with the previous diagnosis of diabetes mellitus, hypertension and dyslipidemia that take a one single dosis of tamsulosin and developed a priapism of 9 hours of duration. He was diagnosticated of low-flow priapism that was reverted after the use of intracavernosal phenylephrine. On the other hand, a 61 years old man without any medical condition. He developed a priapism after the intake of also one single dosis of tamsulosin and came to the hospital after 48 hours of the beginning of the erection. In this case, the use of intracavernosal phenylephrine wasn´t effective so we decided to performed a distal shunt between cavernosal and spongy body according to the techniques of Winter, Ebbehoj and Al-Ghorab. All of them without results. At the end, we tried a proximal shunt according Quackles technique, also ineffective. The patient declined another surgery for implantation of a pennis prothesis and went home after four days of hospitalization with the disappearance of the pain. Conclusions: The tamsulosin is a drug well known by urologist that have a safety profile probed with the years. Nevertheless, it's association with a disease like the priapism forced us to explain to our patients this rare adverse effect (AU)

Objetivo: Describir la fisiopatología del priapismoasociado a tamsulosina a través de dos casos clínicos tratados en nuestro centro.Método: Se presentan dos casos de varones que desarrollan un priapismo isquémico tras la toma de tamsulosina yque fueron tratados en nuestro hospital. Describimos amboscasos, desde el diagnóstico hasta el tratamiento. Además,revisamos la literatura científica sobre dicho tema.Resultado: Introducimos el caso de un hombre de 67años con comorbilidad cardiovascular que desarrolla un priapismo isquémico de 9 horas de duración que revirtió confenilefrina intracavernosa. Por otro lado, se presenta el casode un varón de 61 años sin patología de base con un priapismo de 48 horas que no mejoró tras tratamiento conservador ni tras cirugía de derivación cavernoso-esponjosa.Conclusiones: La tamsulosina es un fármaco seguroque en, raras ocasiones, puede asociarse a un priapismo isquémico. (AU)

Initial Experience in the Use of Novel Auto-expandable Metal Ureteral Stent in the Treatment of Ureter Stenosis in Kidney Transplanted Patients.

INTRODUCTION: Ureter stenosis in renal transplantation patients is a relatively frequent complication that negatively conditions graft evolution. The use of ureteral stents is a valid treatment alternative to the use of double-J catheters in patients for whom surgery is not contemplated or after surgical recurrence. We present our initial experience with five patients treated using this technique. MATERIALS AND METHODS: We describe a total of five patients with ureteral stenosis after renal transplantation who were treated using ureteral stent model UVENTA (Taewoong Medical, Seoul, Korea) in our center. The median follow-up was 18 months (range, 4 to 38 months). We describe the clinical history of patients and previous treatments on ureteral stenosis. The technical procedure of placement is described. The clinical course is analyzed by measurement of renal function and imaging tests, as well as post-stent complications. Survival of the renal graft is evaluated. RESULTS: The procedure could be completed in all patients without complications. The technique was effective in all patients, with correction of creatinine value and hydronephrosis during the renal ultrasound test. One patient suffered a urinary tract infection episode associated with the use of the ureteral stent. One patient suffered the loss of the renal graft secondary to the development of cryoglobulins. One hundred percent of the ureteral stents are functioning as of the writing of this article. CONCLUSIONS: In renal transplantation patients with ureter stenosis, metallic stents are a useful technique with low morbidity and associated complications.

Expresión de las proteínas FGFR3, PI3K, AKT, p21Waf1/Cip1 y ciclinas D1 y D3 en pacientes con tumores de vejiga T1: implicaciones clínicas y significado pronóstico / Expression of proteins FGFR3, PI3K, AKT, p21Waf1/Cip1 and cyclins D1 and D3 in patients with T1 bladder tumours: clinical implications and prognostic significance

Objetivo: Determinar la expresión proteica diferencial de los biomarcadores FGFR3, PI3K (subunidades PI3Kp110α, PI3KClassIII, PI3Kp85), AKT, p21Waf1/Cip1 y las ciclinas D1 y D3 en el cáncer de vejiga T1 versus tejido sano, así como estudiar su posible papel como marcadores de recidiva precoz. Material y método: Se trata de un estudio prospectivo en el que se utilizaron un total de 67 muestras de tejido (55 casos de tumores de vejiga T1 sometidos a resección transuretral y 12 casos de mucosa sana adyacente). Los niveles de expresión de las proteínas se evaluaron mediante Western blot, y las medias y los porcentajes fueron comparados utilizando el test «t» de Student y la prueba Chi cuadrado. El análisis de supervivencia se realizó mediante el método Kaplan-Meier y el test Log-rank. Resultados: Se detectó una mayor expresión proteica de FGFR3, PI3Kp110α, PI3KClassIII, ciclinas D1 y D3 y p21Waf1/Cip1 en tejido tumoral versus mucosa sana. Sin embargo, estas diferencias no fueron significativas para PI3Kp85 y AKT. Se observaron correlaciones estadísticamente significativas de PI3Kp110α, PI3KClassIII, PI3Kp85 y AKT con la recidiva temprana (p = 0,003, p = 0,045, p = 0,050 y p = 0,028 respectivamente), de ciclina D3 (p=0,001) con el tipo tumoral (primario versus recidivante), de FGFR3 (p = 0,035) con el tamaño tumoral y de ciclina D1 (p = 0,039) con la multifocalidad. El análisis de supervivencia seleccionó a FGFR3 (p = 0,024), PI3Kp110alfa (p = 0,014), PI3KClassIII (p = 0,042) y AKT (p= 0,008) como marcadores de supervivencia libre de recidiva precoz. Conclusiones: Existe un incremento de los niveles de expresión proteica en el tejido tumoral vesical, asimismo, la sobreexpresión de FGFR3, PI3Kp110α, PI3KClassIII y AKT se asocia con una mayor supervivencia libre de recidiva precoz en pacientes con tumores de vejiga T1

Objective: To determine the differential protein expression of biomarkers FGFR3, PI3K (subunits PI3Kp110α, PI3KClassIII, PI3Kp85), AKT, p21Waf1/Cip1 and cyclins D1 and D3 in T1 bladder cancer versus healthy tissue and to study their potential role as early recurrence markers. Material and method: This is a prospective study that employed a total of 67 tissue samples (55 cases of T1 bladder tumours that underwent transurethral resection and 12 cases of adjacent healthy mucosa). The protein expression levels were assessed using Western blot, and the means and percentages were compared using Student's t-test and the chi-squared test. The survival analysis was conducted using the Kaplan-Meier method and the log-rank test. Results: Greater protein expression was detected for FGFR3, PI3Kp110α, PI3KClassIII, cyclins D1 and D3 and p21Waf1/Cip1 in the tumour tissue than in the healthy mucosa. However, these differences were not significant for PI3Kp85 and AKT. We observed statistically significant correlations between early recurrence and PI3Kp110α, PI3KClassIII, PI3Kp85 and AKT (P = .003, P = .045, P = .050 and P = .028, respectively), between the tumour type (primary vs. recurrence) and cyclin D3 (P=.001), between the tumour size and FGFR3 (P = .035) and between multifocality and cyclin D1 (P = .039). The survival analysis selected FGFR3 (P = .024), PI3Kp110α (P = .014), PI3KClassIII (P = .042) and AKT (P = .008) as markers of early-recurrence-free survival. Conclusions:. There is an increase in protein expression levels in bladder tumour tissue. The overexpression of FGFR3, PI3Kp110α, PI3KClassIII and AKT is associated with increased early-recurrence-free survival for patients with T1 bladder tumours

Expression of proteins FGFR3, PI3K, AKT, p21Waf1/Cip1 and cyclins D1 and D3 in patients with T1 bladder tumours: clinical implications and prognostic significance. / Expresión de las proteínas FGFR3, PI3K, AKT, p21Waf1/Cip1 y ciclinas D1 y D3 en pacientes con tumores de vejiga T1: implicaciones clínicas y significado pronóstico.

OBJECTIVE: To determine the differential protein expression of biomarkers FGFR3, PI3K (subunits PI3Kp110α, PI3KClassIII, PI3Kp85), AKT, p21Waf1/Cip1 and cyclins D1 and D3 in T1 bladder cancer versus healthy tissue and to study their potential role as early recurrence markers. MATERIAL AND METHOD: This is a prospective study that employed a total of 67 tissue samples (55 cases of T1 bladder tumours that underwent transurethral resection and 12 cases of adjacent healthy mucosa). The protein expression levels were assessed using Western blot, and the means and percentages were compared using Student's t-test and the chi-squared test. The survival analysis was conducted using the Kaplan-Meier method and the log-rank test. RESULTS: Greater protein expression was detected for FGFR3, PI3Kp110α, PI3KClassIII, cyclins D1 and D3 and p21Waf1/Cip1 in the tumour tissue than in the healthy mucosa. However, these differences were not significant for PI3Kp85 and AKT. We observed statistically significant correlations between early recurrence and PI3Kp110α, PI3KClassIII, PI3Kp85 and AKT (P=.003, P=.045, P=.050 and P=.028, respectively), between the tumour type (primary vs. recurrence) and cyclin D3 (P=.001), between the tumour size and FGFR3 (P=.035) and between multifocality and cyclin D1 (P=.039). The survival analysis selected FGFR3 (P=.024), PI3Kp110α (P=.014), PI3KClassIII (P=.042) and AKT (P=.008) as markers of early-recurrence-free survival. CONCLUSIONS: There is an increase in protein expression levels in bladder tumour tissue. The overexpression of FGFR3, PI3Kp110α, PI3KClassIII and AKT is associated with increased early-recurrence-free survival for patients with T1 bladder tumours.

Prostate Cancer Patients-Negative Biopsy Controls Discrimination by Untargeted Metabolomics Analysis of Urine by LC-QTOF: Upstream Information on Other Omics.

The existing clinical biomarkers for prostate cancer (PCa) diagnosis are far from ideal (e.g., the prostate specific antigen (PSA) serum level suffers from lack of specificity, providing frequent false positives leading to over-diagnosis). A key step in the search for minimum invasive tests to complement or replace PSA should be supported on the changes experienced by the biochemical pathways in PCa patients as compared to negative biopsy control individuals. In this research a comprehensive global analysis by LC-QTOF was applied to urine from 62 patients with a clinically significant PCa and 42 healthy individuals, both groups confirmed by biopsy. An unpaired t-test (p-value < 0.05) provided 28 significant metabolites tentatively identified in urine, used to develop a partial least squares discriminant analysis (PLS-DA) model characterized by 88.4 and 92.9% of sensitivity and specificity, respectively. Among the 28 significant metabolites 27 were present at lower concentrations in PCa patients than in control individuals, while only one reported higher concentrations in PCa patients. The connection among the biochemical pathways in which they are involved (DNA methylation, epigenetic marks on histones and RNA cap methylation) could explain the concentration changes with PCa and supports, once again, the role of metabolomics in upstream processes.

Graft Survival in Patients Who Received Second Allograft, Comparing Those With or Without Previous Failed Allograft Nephrectomy.

INTRODUCTION: Nowadays, the number of patients receiving a second graft is growing, and the management of failed grafts is still controversial. OBJECTIVE: Our objective was to analyze the influence of graft nephrectomy on graft and patient survival. MATERIALS AND METHODS: We retrospectively evaluated the demographic features and graft outcomes of 63 recipients who received second allografts between August 1985 and April 2013. They were divided into two groups: group A, those who underwent nephrectomy of failed graft (n = 21, 33.3%), and group B, those whose failed graft was retained (n = 42, 66.6%). χ2 and Mann-Whitney U tests were used to compare demographic characteristics and graft features in both groups. Kaplan-Meier test was used to analyze graft and patient survival. Finally, univariate and multivariate analysis was done using Cox regression. RESULTS: Demographic characteristics of donor and receptors were similar in both groups. Overall panel-reactive antibody (P = .040) showed statistically significant differences between groups (72.0 ± 25.3 in group A and 54.8 ± 30.0 in group B). Hemodialysis duration was longer in group A (P = .023, 112.2 ± 72.8 vs 70.9 ± 66.9 months). The percentage of patients who had delayed graft function was higher in group A (58.8% vs 27.3%, P = .029). Kaplan-Meier test found no differences between groups (P = .344); group A, 107.4 months (95% confidence interval [CI] 74.0 to 140.8) and group B, 82.7 months (95% CI 62.5 to 102.8). We found no differences in terms of patient survival (P = .798) with the Kaplan-Meier test. In group A, patient survival was 164.5 months (CI 137.7 to 191.31) and in group B, 152.0 months (95% CI 125.5 to 178.5). CONCLUSIONS: Failed graft nephrectomy did not show a negative impact on graft and patient survival.

Valor pronóstico de la ecografía doppler color peneana en la recuperación de la función eréctil tras prostatectomía radical / Prognostic value of penile colour doppler ultrasonography for recovering erectile function after radical prostatectomy

Objetivo: Analizar la utilidad predictiva de la ecografía doppler color peneana tras la inyección de vasoactivos en la recuperación de la función eréctil tras prostatectomía radical. Material y métodos: Estudio retrospectivo en pacientes con disfunción eréctil tras prostatectomía radical tratados con inyecciones intracavernosas de prostaglandinas E1 entre el 1 de enero de 2006 y el 31 de diciembre de 2012. Se incluyeron enfermos sin antecedente de disfunción eréctil previa a la cirugía, no respondedores a tratamiento médico. En todos se realizó eco doppler color tras la inyección intracavernosa. Una velocidad picosistólica ≥ 30cm/seg y una velocidad diastólica final ≤ 5cm/seg fueron considerados valores hemodinámicos normales. Se evaluó el resultado del tratamiento durante el seguimiento mediante el uso de IIEF-5. Resultados: Se incluyeron 197 pacientes. La edad media fue de 60,8 (± 6,3DE). El diagnóstico anatomopatológico en todos ellos fue de adenocarcinoma, siendo el 74,1% organoconfinados (T1-T2/Nx-N0). El tratamiento con inyecciones tras la cirugía se inició una vez transcurridos 6,8 meses de media (± 3,5 DE). La ecografía doppler fue normal en 53 pacientes (26,9%). Durante el seguimiento, 113 pacientes (57,4%) mantenían erecciones funcionales, estando 55 de ellos (28%) sin necesidad de inyecciones. La presencia de una ecografía doppler normal se asoció a una respuesta favorable al tratamiento (p < 0,01). Conclusiones: El test de prostaglandina E1 nos va a permitir una orientación diagnóstica en la disfunción eréctil de los pacientes prostatectomizados. Permite obtener información sobre el estado vascular del pene y aporta información pronóstica de utilidad en el seguimiento de estos pacientes

Objective: To analyse the predictive utility of penile colour Doppler ultrasonography after the injection of vasoactive agents for recovering erectile function after radical prostatectomy. Material and methods: A retrospective study was conducted on patients with erectile dysfunction after radical prostatectomy who were treated with intracavernous injections of prostaglandins E1 between January 1, 2006 and December 31, 2012. The study included patients with no history of erectile dysfunction prior to the surgery and who did not respond to medical treatment. Colour Doppler was performed on all patients after the intracavernous injection. A peak systolic velocity ≥ 30cm/sec and an end diastolic velocity ≤ 5cm/sec were considered normal haemodynamic values. We assessed the result of the treatment during the follow-up using the International Index of Erectile Function-5. Results: We included 197 patients. The mean age was 60.8 (± 6.3). The pathological diagnosis for all patients was adenocarcinoma, 74.1% of which were confined to the organ (T1-T2/Nx-N0). Treatment with injections after the surgery was started after a mean duration of 6.8 months (+3.5). The Doppler ultrasonography results were normal for 53 patients (26.9%). During the follow-up, 113 patients (57.4%) maintained functional erections; 55 of these patients (28%) did not require injections. Normal Doppler ultrasonography results were associated with a favourable response to treatment (p < .01). Conclusions: The prostaglandin E1 test will help provide a diagnosis in erectile dysfunction for patients who have undergone prostatectomies. The test helps provide information on the vascular condition of the penis and useful prognostic information for the follow-up of these patients

Prognostic value of penile colour doppler ultrasonography for recovering erectile function after radical prostatectomy. / Valor pronóstico de la ecografía doppler color peneana en la recuperación de la función eréctil tras prostatectomía radical.

OBJECTIVE: To analyse the predictive utility of penile colour Doppler ultrasonography after the injection of vasoactive agents for recovering erectile function after radical prostatectomy. MATERIAL AND METHODS: A retrospective study was conducted on patients with erectile dysfunction after radical prostatectomy who were treated with intracavernous injections of prostaglandins E1 between January 1, 2006 and December 31, 2012. The study included patients with no history of erectile dysfunction prior to the surgery and who did not respond to medical treatment. Colour Doppler was performed on all patients after the intracavernous injection. A peak systolic velocity ≥30cm/sec and an end diastolic velocity ≤5cm/sec were considered normal haemodynamic values. We assessed the result of the treatment during the follow-up using the International Index of Erectile Function-5. RESULTS: We included 197 patients. The mean age was 60.8 (±6.3). The pathological diagnosis for all patients was adenocarcinoma, 74.1% of which were confined to the organ (T1-T2/Nx-N0). Treatment with injections after the surgery was started after a mean duration of 6.8 months (+3.5). The Doppler ultrasonography results were normal for 53 patients (26.9%). During the follow-up, 113 patients (57.4%) maintained functional erections; 55 of these patients (28%) did not require injections. Normal Doppler ultrasonography results were associated with a favourable response to treatment (p<.01). CONCLUSIONS: The prostaglandin E1 test will help provide a diagnosis in erectile dysfunction for patients who have undergone prostatectomies. The test helps provide information on the vascular condition of the penis and useful prognostic information for the follow-up of these patients.

Partial thrombosis of the corpus cavernosum: should we dig deeper into coagulopathy disorders?

Partial thrombosis of the corpus cavernosum, also known as partial priapism is a rare condition. The condition is known to be unilateral, and its aetiology is not well known. Usually, symptoms are pain and perineal mass and Magnetic Resonance is needed to confirm the diagnosis. In most cases the treatment is conservative with anticoagulation therapy. We present a case of partial thrombosis of the corpus cavernosum with a Factor V Leyden mutation.

Evaluación del dolor y factores asociados en pacientes sometidos a biopsia de próstata / Assessment and clinical factors associated with pain in patients undergoing transrectal prostate biopsy

Objetivos: Cuantificar el grado de dolor que sufren los pacientes sometidos a biopsia transrectal de próstata ecodirigida en la práctica clínica habitual, y evaluar qué factores clínicos se encuentran asociados a un mayor dolor. Material y métodos: Análisis de una serie multicéntrica de pacientes con biopsia de próstata según la práctica clínica habitual. La biopsia se realizó vía transrectal con un protocolo de anestesia local sobre el paquete nervioso posterolateral. Se evaluó el dolor a los 20 min del procedimiento a través de la escala visual analógica (0-10). Se analiza el grado de dolor soportado y se estudia la asociación de forma uni/multivariante de variables clínicas seleccionadas y el grado de dolor. Resultados: Se analizaron un total de 1.188 pacientes de 64 años de mediana de edad. Un 30% de las biopsias fueron diagnósticas de tumor. La mediana de dolor fue de 2, con un 65% de pacientes con dolor ≤ 2. El análisis multivariante muestra que el volumen prostático (RR: 1,34, IC 95%: 1,01-1,77; p = 0,04), el hecho de tener una biopsia previa (RR: 2,25, IC 95%: 1,44-3,52; p < 0,01), la edad (RR:0,63, IC 95%: 0,47-0,85; p < 0,01) y un tacto doloroso (RR: 1,95, IC 95%: 1,28-2,96; p < 0,01), son factores asociados de forma independiente con mayor dolor durante el procedimiento. Conclusiones: La biopsia transrectal con anestesia local es una técnica poco dolorosa. Factores como la edad, una biopsia previa, un tacto doloroso y el volumen prostático se asocian con la presencia de un mayor dolor durante el procedimiento

Objectives: To quantify the degree of pain experienced by patients who undergo ultrasound-guided transrectal prostate biopsy in standard clinical practice and assess the clinical factors associated with increased pain. Material and methods: Analysis of a multicenter series of patients with prostate biopsy according to standard clinical practice. The biopsy was performed transrectally with a protocol of local anesthesia on the posterolateral nerve bundle. The pain was assessed at 20 minutes into the procedure using the visual analog scale (0-10). The degree of pain was analyzed, and the association was studied using a univariate/multivariate analysis of selected clinical variables and the degree of pain. Results: A total of 1188 patients with a median age of 64 years were analyzed. Thirty percent of the biopsies were diagnosed with a tumor. The median pain score was 2, with 65% of the patients reporting a pain score ≤ 2. The multivariate analysis showed that the prostate volume (RR, 1.34; 95% CI 1.01-1.77; P = .04), having a previous biopsy (RR, 2.25; 95% CI 1.44-3.52; P < .01), age (RR, .63; 95% CI .47-.85; P < .01) and feel palpation (RR, 1.95; 95% CI 1.28-2.96; P < .01) were factors independently associated with greater pain during the procedure. Conclusions: Transrectal biopsy with local anesthesia is a relatively painless technique. Factors such as age, a previous biopsy, pain on being touched and prostate volume were associated with the presence of greater pain during the procedure

Impacto de la visión 3D sobre la carga mental y el rendimiento laparoscópico en individuos sin experiencia / Impact of 3D vision on mental workload and laparoscopic performance in inexperienced subjects

Objetivo: Evaluar el efecto de la visión en 3 dimensiones (3D) en comparación con 2 dimensiones (2D) sobre la carga mental de trabajo soportada y el rendimiento laparoscópico en ejercicios de simulación. Material y métodos: Se llevó a cabo un estudio prospectivo aleatorizado cruzado en sujetos sin experiencia en laparoscopia. Se incluyeron 46 participantes, los cuales completaron 5 ejercicios en pelvitrainer basados en un programa validado usando ambos sistemas de visión. El rendimiento se evaluó mediante el tiempo transcurrido y el número de errores cometidos, y la carga mental de trabajo a través del cuestionario validado NASA-TLX. Resultados: Los participantes realizaron las actividades mejor con la visión 3D de forma global en términos de tiempo (3D = 1.006,08 ± 315,94 vs. 2D = 1.309,17 ± 300,28; p < 0,001) y número total de errores (3D = 0,84 ± 1,26 vs. 2D = 1,86 ± 1,60; p < 0,001). Cuando se analizó el tiempo de forma independiente por ejercicios, el uso de 3D mostró diferencias estadísticamente significativas en: «transferencia de objetos» (p = 0,001), «sutura» (p < 0,001), «clipar y cortar» (p < 0,05) y «manejo de la aguja» (p < 0,001). Además, el uso de la visión 3D produjo menos carga mental de trabajo de acuerdo con los resultados del NASA-TLX (p < 0,001), aunque se asoció con un mayor malestar visual (p < 0,01) y dolor de cabeza (p < 0,05). Conclusión: La incorporación de sistemas 3D en cirugía laparoscópica facilitaría la adquisición más temprana de habilidades laparoscópicas, ya que se asocia a un mejor rendimiento y menor carga mental de trabajo en sujetos sin experiencia, si bien existen inicialmente algunos efectos indeseables como malestar visual o dolor de cabeza (AU)

Objective: To assess the effect of vision in three dimensions (3D) versus two dimensions (2D) on mental workload and laparoscopic performance during simulation-based training. Materials and methods: A prospective, randomized crossover study on inexperienced students in operative laparoscopy was conducted. Forty-six candidates executed five standardized exercises on a pelvitrainer with both vision systems (3D and 2D). Laparoscopy performance was assessed using the total time (in seconds) and the number of failed attempts. For workload assessment, the validated NASA-TLX questionnaire was administered. Results: 3D vision improves the performance reducing the time (3D = 1006.08 ± 315.94 vs. 2D = 1309.17 ± 300.28; P < .001) and the total number of failed attempts (3D = .84 ± 1.26 vs. 2D = 1.86 ± 1.60; P < .001). For each exercise, 3 D vision also shows better performance times: «transfer objects» (P = .001), «single knot» (P < .001), «clip and cut» (P < .05), and «needle guidance» (P < .001). Besides, according to the NASA-TLX results, less mental workload is experienced with the use of 3 D (P < .001). However, 3 D vision was associated with greater visual impairment (P < .01) and headaches (P < .05). Conclusion: The incorporation of 3 D systems in laparoscopic training programs would facilitate the acquisition of laparoscopic skills, because they reduce mental workload and improve the performance on inexperienced surgeons. However, some undesirable effects such as visual discomfort or headache are identified initially (AU)

Assessment and clinical factors associated with pain in patients undergoing transrectal prostate biopsy.

OBJECTIVES: To quantify the degree of pain experienced by patients who undergo ultrasound-guided transrectal prostate biopsy in standard clinical practice and assess the clinical factors associated with increased pain. MATERIAL AND METHODS: Analysis of a multicenter series of patients with prostate biopsy according to standard clinical practice. The biopsy was performed transrectally with a protocol of local anesthesia on the posterolateral nerve bundle. The pain was assessed at 20minutes into the procedure using the visual analog scale (0-10). The degree of pain was analyzed, and the association was studied using a univariate/multivariate analysis of selected clinical variables and the degree of pain. RESULTS: A total of 1188 patients with a median age of 64 years were analyzed. Thirty percent of the biopsies were diagnosed with a tumor. The median pain score was 2, with 65% of the patients reporting a pain score ≤2. The multivariate analysis showed that the prostate volume (RR, 1.34; 95% CI 1.01-1.77; P=.04), having a previous biopsy (RR, 2.25; 95% CI 1.44-3.52; P<.01), age (RR, .63; 95% CI .47-.85; P<.01) and feel palpation (RR, 1.95; 95% CI 1.28-2.96; P<.01) were factors independently associated with greater pain during the procedure. CONCLUSIONS: Transrectal biopsy with local anesthesia is a relatively painless technique. Factors such as age, a previous biopsy, pain on being touched and prostate volume were associated with the presence of greater pain during the procedure.

Influence of surgical complications on kidney graft survival in recipients of simultaneous pancreas kidney transplantation.

PURPOSE: Simultaneous pancreas-kidney transplantation is the gold standard treatment for patients with end-stage renal failure secondary to insulin-dependent diabetes mellitus. This kind of transplantation is a complex operation associated with a high incidence of surgical complications and mortality risk which could influence graft survival. The aim of this study was to establish the influence of different grades of postoperative complications, classified according to Clavien-Dindo, on the rate of kidney graft loss. METHODS: We performed an observational retrospective review of all simultaneous transplantations performed between February 1989 and May 2012. Factors examined were related to recipient and donor characteristics, surgical procedures, and postoperative outcomes. For this purpose, Kaplan-Meier analyses and Cox-Regression tests are used. RESULTS: One hundred thirty-nine transplantations were performed. Complications grades I, II, and IIIa were experienced in 81 (58.3%) patients, and grades IIIb and IVa-b in 55 (39.6%). Multivariate analysis showed an influence of panel reactive antibody (hazard ratio [HR]: 10.79; P = .003), incidence of acute rejection (HR: 2.55; P = .03), and complications grouped into grades IIIb and IVa-b (HR: 3.63; P = .02). Kaplan Meier analysis showed worse kidney graft survival rate in groups grades IIIb and IVa-b compared to grades I, II, and IIIa (86.6% vs 98.7% at 1 year and 81.8% vs 97.3% at 5 years; P = .001). CONCLUSIONS: Despite being the gold standard treatment for these patients, pancreas and kidney transplantations have numerous complications which could influence the prognosis of graft kidney survival.

Impact of 3D vision on mental workload and laparoscopic performance in inexperienced subjects.

OBJECTIVE: To assess the effect of vision in three dimensions (3D) versus two dimensions (2D) on mental workload and laparoscopic performance during simulation-based training. MATERIALS AND METHODS: A prospective, randomized crossover study on inexperienced students in operative laparoscopy was conducted. Forty-six candidates executed five standardized exercises on a pelvitrainer with both vision systems (3D and 2D). Laparoscopy performance was assessed using the total time (in seconds) and the number of failed attempts. For workload assessment, the validated NASA-TLX questionnaire was administered. RESULTS: 3D vision improves the performance reducing the time (3D = 1006.08 ± 315.94 vs. 2D = 1309.17 ± 300.28; P < .001) and the total number of failed attempts (3D = .84 ± 1.26 vs. 2D = 1.86 ± 1.60; P < .001). For each exercise, 3D vision also shows better performance times: "transfer objects" (P = .001), "single knot" (P < .001), "clip and cut" (P < .05), and "needle guidance" (P < .001). Besides, according to the NASA-TLX results, less mental workload is experienced with the use of 3D (P < .001). However, 3D vision was associated with greater visual impairment (P < .01) and headaches (P < .05). CONCLUSION: The incorporation of 3D systems in laparoscopic training programs would facilitate the acquisition of laparoscopic skills, because they reduce mental workload and improve the performance on inexperienced surgeons. However, some undesirable effects such as visual discomfort or headache are identified initially.

[Ablation of malignant liver tumors with radiofrequency. A series of cases in Mexico.]. / Ablación de neoplasias hepáticas malignas con radiofrecuencia. Una serie de casos en México.

BACKGROUND: Surgical resection is the treatment of choice for most of the primary and secondary liver tumors, unfortunately, many patients are not suitable for resection. Several ablative alternatives have been employed for treatment; the most commonly used has been radiofrequency ablation. OBJECTIVE: To establish the safety and results of treatment with radiofrequency ablation (RF) of malignant liver tumors. MATERIAL AND METHODS: A retrospective review of clinical files of patients with malignant hepatic tumors treated with RF was performed. Epidemiological variables, selection criteria pre- treatment and morbidity and mortality related to the procedure were analyzed. Descriptive statistics were used. RESULTS: From September 2002 to August 2006, 30 patients were treated: eighteen females and 12 males with a median age of 62 years (range 41-83 years). Histologic type was as follows: 18 hepatocellular carcinomas; 10 metastatic tumors (four breast, four colorectal and two neuro- endocrine); one gallbladder carcinoma and one peripheral cholangiocarcinoma. Indications for ablative procedure were the presence of cirrhosis, poor functional reserve, bilobar disease, proximity to major vascular structures and patients with increased operative risk. The size of the lesion range from 2 to 20 cm (mean 5.6 cm) and the median time of ablation was 30.2 min (range 5-50 min). Two minor complications (6.6%) and no operative mortality were recorded. At 18 months of follow-up, 23 patients (76.6%) are still alive and seven patients have died for tumor progression. CONCLUSION: Radiofrequency ablation is a safe procedure that allows local control of the disease with satisfactory results, when the surgical resection is not feasible.

Role in pathogenesis of two endo-beta-1,4-xylanase genes from the vascular wilt fungus Fusarium oxysporum.

A gene, xyl4, whose predicted amino acid sequence shows significant homology with family 11 xylanases, was identified from the tomato vascular wilt fungus Fusarium oxysporum f. sp. lycopersici. Expression of xyl4 is induced on oat spelt xylan as the carbon source, subject to carbon catabolite repression and preferentially expressed at alkaline ambient pH. Transcript levels of xyl4 on an inducing carbon source are differentially regulated by the nature and concentration of the nitrogen source. As shown by RT-PCR, xyl4 is expressed by F. oxysporum during the entire cycle of infection on tomato plants. Targeted inactivation of xyl4 and of xyl3, a previously identified gene of F. oxysporum f. sp. lycopersici encoding a family 10 xylanase, had no detectable effect on virulence on tomato plants, demonstrating that both genes are not essential for pathogenicity.

Molecular characterization of a novel endo-beta-1,4-xylanase gene from the vascular wilt fungus Fusarium oxysporum.

A gene, xyl5, was identified from the tomato vascular wilt fungus Fusarium oxysporum f.sp. lycopersici, whose predicted amino acid sequence shows significant homology with family 11 xylanases. Expression of xyl5 was detected during growth both on xylan and cellulose substrates as carbon sources and on tomato vascular tissue. RT-PCR analysis revealed the presence of two different transcript sizes, resulting from differential splicing of the third intron. The 3'-untranslated region of the xyl5 transcript contained a region of homology to cellulose-binding domains, suggesting that such a domain may have been part of an ancestral XYL5 version. As shown by RT-PCR, xyl5 is expressed by F. oxysporum exclusively during the initial stages of infection in tomato roots. Targeted inactivation of xyl5 had no detectable effect on virulence.

Role of cell wall-degrading enzymes in pathogenicity of Fusarium oxysporum.

Fusarium oxysporum invades its host plants through the roots and colonizes the vascular system. It produces a great variety of cell-wall degrading enzymes (CWDE), such as cellulases, xylanases, pectinases and proteases. Our group has purified and characterized an endopolygalacturonase (PG1), two exopolygalacturonases (PG2 and PG3), an endoxylanase (XYL1) and an endo pectatelyase (PL1). We have isolated the following CWDE-encoding genes: pg1, pgx4, pg5, xyl2, xyl3, prt1 and pl1. Gene expression in different culture conditions has been determined by Northern analysis. The occurrence of these genes in different formae speciales has been analyzed by Southern analysis and PCR. All these genes are expressed during different stages of the interaction with the host plant indicating a possible role in pathogenesis. At present, targeted gene disruption is being carried out, in order to determine the role of each gene in the pathogenicity process.

Folyt1, a new member of the hAT family, is active in the genome of the plant pathogen Fusarium oxysporum.

An active transposable element, Folyt1, has been isolated from the tomato pathogen Fusarium oxysporum f. sp. lycopersici as an insertion sequence within the coding region of the nitrate reductase gene (nit 1) in two independent mutants (CO66 and CO108). Folyt1 was 2615 bp in length and contained 9-bp imperfect inverted terminal repeats (ITRs) and 8 bp duplicated at the target site upon insertion. The element contained a long open reading frame interrupted by a single putative intron. The predicted amino acid sequence showed similarity to conserved domains of transposases from hobo, Ac, and Tam3 elements, which belong to the hAT family. The excision frequency of Folyt1 was determined to be less than 10(-5) in both mutants. These events restored the nit 1 wild-type allele without leaving footprints in all the revertants of strain CO66. Nevertheless, some revertants of strain CO108 showed a point mutation footprint at the target sequence. Expression of the Folyt1 transposase was detected by Northern analysis as a 2.1-kb transcript. The element exists in about 10 copies per genome in F. oxysporum f. sp. lycopersici and appears to be widely distributed among different formae speciales of F. oxysporum.