Corkscrew Technique for Extraction of Premolars and Molars in Standing Sedated Horses: Cadaveric Study and Clinical Cases.

Several tooth extraction techniques are described in equine literature, and oral extraction techniques in standing sedated horses are popular among equine practitioners. The objectives of this study were to develop the corkscrew technique for cheek tooth extraction (CSET) in equine cadaver heads and evaluate this technique in clinical cases. We hypothesized that the CSET could be performed safely to extract cheek teeth in standing sedated horses. First, the CSET was attempted and developed in eight equine cadaver heads. Second, the CSET was performed in clinical cases between 2016 and 2020, and the following information was recorded: diagnosis, affected tooth, procedure duration, intraoperative difficulties, tooth size, postoperative complications, medication, hospitalization time, and 1-year follow-up. Sixteen CSET procedures were performed in eight equine skulls with a 75% success rate. In 24 clinical cases, 25 CSET procedures were attempted to extract 22 superior and 3 inferior cheek teeth. CSET was successful in 76% of procedures. Fractures of the tooth and stripping of screw threads were the major complications that led to the failure of CSET. CSET is a viable and safe technique to extract cheek teeth in standing sedated horses. Longitudinal drilling is a must for this technique to be successful.

Corticodependent and recurrent inflammatory pseudo tumor. Analysis of cases and review.

Inflammatory pseudo tumor (IP) is an infrequent process with benign evolution in most cases whose etiology and pathogenesis are unknown. It usually affects young men and children, in whom the macroscopic lesion can mimic a malignant process, which is ruled out after biopsy. Therefore, the diagnosis of certainty is histological and treatment consists of corticosteroids, leaving resection for cases in which biopsy is not possible or in which it produces local complications. We present a case of an inflammatory pseudo tumor with special corticodependence that began as a long-term periodic fever and splenic focal lesion that required splenectomy for its diagnosis and that, after decreasing the corticosteroid regimen, presented recurrences at the cerebellar and systemic level requiring the association of various immunosuppressants and rituximab to achieve remission. As a result of this case, we have performed an analysis of all the pseudo tumors diagnosed in adults in the hospitals of the province of Malaga, and it has been compared with that described in the bibliography.

Safety of the Administration of an Inactivated PCV2a/PCV2b/Mycoplasma Hyopneumoniae Vaccine to Pregnant and Lactating Sows and Gilts.

Porcine Circovirus type 2 (PCV2) vaccination of gilts during acclimation has become a routine practice in commercial pig farms to homogenize herd immunity to PCV2 and reduce the impact of diseases associated with PCV2 infection, namely reproductive, respiratory, systemic, and other PCV2-associated diseases. The periodic mass vaccination of sows, with the same objectives, is also common. To ensure mass vaccination is an appropriate health management tool, demonstrating that the vaccine is safe in different sow/gilt physiological stages is necessary. The objective of the present studies was to evaluate safety of a PCV2a/PCV2b/Mycoplasma hyopneumoniae (PCV2a2bMHP) killed vaccine in sows and gilts during gestation and lactation, under controlled experimental pen conditions, and during gestation, mimicking mass vaccination, under field conditions. Safety was assessed by monitoring for immediate adverse reactions after vaccination, rectal temperatures after vaccination (controlled experimental pen studies only), local and systemic reactions, and reproductive performance (studies conducted during pregnancy) or lactation performance (studies conducted during lactation). In total, 416 sows/gilts were enrolled, and more than 4000 piglets were observed during their first week of life, under field conditions. In both controlled experimental and field studies, no immediate anaphylactic type reactions were observed after vaccination and the incidence of adverse events, such as depression or decreased appetite, was acceptable for what is expected in a swine herd. In the studies conducted during gestation, vaccination did not significantly increase rectal temperature of the vaccinated animals. Sow reproductive outcomes were not affected by vaccination. The farrowing rate of animals participating in the field study was higher than the historic averages of the farms. In the laboratory studies conducted during the first and second half of gestation, no differences in reproductive outcome were observed between vaccinated and non-vaccinated animals. However, sows vaccinated during lactation experienced a transient hyperthermia which did not affect milk production since the piglets' average daily weight gain was not affected. The previously described results confirm that the administration of a PCV2a2bMHP vaccine was safe in the tested conditions. All the anticipated benefits of sow and gilt PCV2 vaccination, such as homogenization of PCV2 antibody titers or reduction in PCV2 circulation in the herd, would not be masked by potential adverse events due to herd vaccination. In conclusion, the administration of a PCV2a2bMHP vaccine to sows and gilts during different stages of gestation and during lactation is safe.

Endoscopic balloon dilation of primary obstructive megaureter: is fluoroscopic guidance necessary?

OBJECTIVE: To compare the long-term effectiveness, complications, and outcomes of primary obstructive megaureter (POM) treated by endoscopic balloon dilation under fluoroscopic guidance versus not using radioscopy during the procedure. PATIENTS AND METHODS: A comparative study between POM cases treated at our institution by endoscopic balloon dilation (EBD) under fluoroscopic guidance (FG) (n = 43) vs no fluoroscopic guidance (NFG) (n = 48) between the years 2004 and 2018 was conducted. The procedure in FG consisted of performing a retrograde pyelography before dilation. Then, a guidewire is introduced to the renal pelvis, and the dilation of the vesicoureteral junction is performed using high-pressure balloon catheters under fluoroscopic vision. Finally, a double-J stent is placed between the renal pelvis and bladder. The procedure in NFG was performed exclusively under cystoscopic vision without radiological exposure. Complications, outcomes, and success rates were analyzed using Spearman's correlation test. Mean follow-up was 12.5 ± 2.2 years in FG and 6.4 ± 1.3 years in NFG. RESULTS: MAG-3 showed significant differences in renal drainage before and after endoscopic treatment in both groups (p < 0.001 T-test). Statistical analysis did not reveal differences between groups in initial technical failure (r: - 0.035, p = 0.74), early postoperative complications (r: - 0.029, p = 0.79), secondary VUR (r: 0.033, p = 0.76), re-stenosis (r: 0.022, p = 0.84), long-term ureteral reimplantation (r: 0.065, p = 0.55), and final outcome (r: - 0.054, p = 0.61). The endoscopic approach of POM had a long-term success rate of 86.5% in FG VS 89.6% in NFG. CONCLUSIONS: Endoscopic balloon dilation of POM can be done with no radiation exposure with similar results, effectiveness, and outcomes.

Infection dynamics and incidence of wild-type porcine reproductive and respiratory syndrome virus in growing pig herds in the U.S. Midwest.

Porcine reproductive and respiratory syndrome virus (PRRSV) infections greatly impact the health and productivity of growing pigs. The introduction and persistence of wild-type PRRSV (WT-PRRSV) strains in growing pig populations is poorly understood. In an observational prospective cohort study, we monitored and surveyed 63 wean-to-finish (WTF) herds across 10 companies located in medium to high pig dense areas in the U.S. Midwest. All herds received weaned pigs from PRRSV-negative or positive-stable breeding herds. Herds were monitored monthly using oral fluids collected following a fixed spatial sampling regime and samples were tested by PRRSV ELISA, RT-PCR and ORF5 sequencing. In most (90%) of the herds, pigs were vaccinated with PRRSV modified-live vaccines either at processing, weaning or shortly after weaning. Wild type PRRSV (WT-PRRSV) infections were defined by the criterion of having more than 2% nucleotide differences in the ORF-5 region compared with reference vaccine strain sequences. Wild type PRRSV was detected in 42% of the herds with infections being more prevalent in the mid to late growing period, with a mean of 20 weeks post placement. Nineteen distinct WT-PRRSV were identified in seven out of 10 production companies with an average of 3 distinct WT-PRRSV strains per company. Vaccinated WTF herds with and without WT-PRRSV detection were compared to each other showing different PCR and ELISA infection patterns. Close-out mortality in vaccinated herds with WT-PRRSV was numerically higher (6.5%) than mortality in those sites where WT-PRRSV was not detected (5.0%) (p = 0.07). Mortality was also higher (10.5%) when WT-PRRSV was detected earlier at eight weeks post-placement compared to late finishing at 20 and 25 weeks post-placement, 2.9% and 4.5% respectively (p = 0.017). Overall, this study sheds light on WT-PRRSV infection dynamics in vaccinated populations of growing pigs, reinforces the importance of biosecurity practices in this phase of production and calls for better understanding of risk factors associated with PRRSV introductions in growing pig sites.

Wavelet-Based Multiscale Intermittency Analysis: The Effect of Deformation.

Intermittency represents a certain form of heterogeneous behavior that has interest in diverse fields of application, particularly regarding the characterization of system dynamics and for risk assessment. Given its intrinsic location-scale-dependent nature, wavelets constitute a useful functional tool for technical analysis of intermittency. Deformation of the support may induce complex structural changes in a signal. In this paper, we study the effect of deformation on intermittency. Specifically, we analyze the interscale transfer of energy and its implications on different wavelet-based intermittency indicators, depending on whether the signal corresponds to a 'level'- or a 'flow'-type physical magnitude. Further, we evaluate the effect of deformation on the interscale distribution of energy in terms of generalized entropy and complexity measures. For illustration, various contrasting scenarios are considered based on simulation, as well as two segments corresponding to different regimes in a real seismic series before and after a significant earthquake.

A Spatially Correlated Model with Generalized Autoregressive Conditionally Heteroskedastic Structure for Counts of Crimes.

Crime is a negative phenomenon that affects the daily life of the population and its development. When modeling crime data, assumptions on either the spatial or the temporal relationship between observations are necessary if any statistical analysis is to be performed. In this paper, we structure space-time dependency for count data by considering a stochastic difference equation for the intensity of the space-time process rather than placing structure on a latent space-time process, as Cox processes would do. We introduce a class of spatially correlated self-exciting spatio-temporal models for count data that capture both dependence due to self-excitation, as well as dependence in an underlying spatial process. We follow the principles in Clark and Dixon (2021) but considering a generalized additive structure on spatio-temporal varying covariates. A Bayesian framework is proposed for inference of model parameters. We analyze three distinct crime datasets in the city of Riobamba (Ecuador). Our model fits the data well and provides better predictions than other alternatives.

EEG Feature Extraction Using Evolutionary Algorithms for Brain-Computer Interface Development.

Brain-computer interfaces are systems capable of mapping brain activity to specific commands, which enables to remotely automate different types of processes in hardware devices or software applications. However, the development of brain-computer interfaces has been limited by several factors that affect their performance, such as the characterization of events in brain signals and the excessive processing load generated by the high volume of data. In this paper, we propose a method based on computational intelligence techniques to handle these problems, turning them into a single optimization problem. An artificial neural network is used as a classifier for event detection, along with an evolutionary algorithm to find the optimal subset of electrodes and data points that better represents the target event. The obtained results indicate our approach is a competitive and viable alternative for feature extraction in electroencephalograms, leading to high accuracy values and allowing the reduction of a significant amount of data.

Long Term Outcome of 112 Pediatric Patients With Ureteroplevic Junction Obstruction Treated by Endourologic Retrograde Balloon Dilatation.

Purpose: To analyze the effectiveness, complications and long-term outcome of the patients with ureteropelvic junction obstruction (UPJO) treated by endoscopic retrograde balloon dilatation (ERBD) in the largest series reported. Materials and Methods: Between years 2004 and 2018, 112 patients with primary unilateral UPJO were treated by ERBD. Endoscopic treatment consisted on a retrograde balloon dilatation of the ureteropelvic junction (UPJ), through cystoscopy and under fluoroscopic guidance, using high-pressure balloon catheters. In case of persistence in the balloon notch, a Cutting Balloon™ catheter was used. Double-J stent was placed after dilatation. Results: Mean age at surgery was 13.1 ± 21.3 months, 92 cases being younger than 18 months. Mean operative time was 24.4 ± 10.3 min; hospital stay was 1 day in 82% of patients. No intraoperative complications occurred. UPJ was calibrated at time of stent removal with cystoscopy 39.1 ± 13.7 days after dilatation. ERBD was not possible in 11 cases. An additional procedure was needed in 24 cases: second ERBD (n = 11, seven during the stent withdrawal), a third dilatation (n = 3) due to persistent hydronephrosis, and percutaneous endopyelotomy (n = 3) or open pyeloplasty (n = 7) in cases of technical failure. Significant improvement in postoperative ultrasound measures were observed (p < 0.05, T-test). Long-term success rate was 76.8% after one dilatation, and 86.6% in those who required up to 2 dilatations. Mean follow-up was 66.7 ± 37.5 months. Conclusions: ERBD is a feasible and safe option for the minimally invasive treatment of UPJ obstruction in infants. Long-term outcome is acceptable with a very low complication rate.

Synthesis, in vitro, in silico and in vivo hypoglycemic and lipid-lowering effects of 4-benzyloxy-5-benzylidene-1,3-thiazolidine-2,4-diones mediated by dual PPAR α/γ modulation.

In current work, we prepared a series of nine 4-benzyloxy-5-benzylidene-1,3-thiazolidine-2,4-diones using a two-step pathway. Compounds 1-9 were tested in vitro using a set of three proteins recognized as important targets in diabetes and related diseases: PPARα, PPARγ, and GLUT-4. Compounds 1-3, 5, and 7 showed significant increases in the mRNA expression of PPARγ and GLUT-4, whereas compounds 1-3 did it over PPARα. Compounds 1-3 were identified as a dual PPAR α/γ modulators and were selected for evaluating the in vivo antidiabetic action at 100 mg/kg dose, being orally actives and decreasing blood glucose concentration in a hyperglycemic mice model, as well as reducing the triacylglycerides levels in normolipidemic rats. Docking and molecular dynamics studies were conducted to clarify the dual effect and binding mode of compounds 1-3 on both PPARs. Compounds 2 and 3 exhibited robust in vitro and in vivo efficacy and could be considered dual PPAR modulators with antidiabetic and antidyslipidemic effects.

Structural Complexity and Informational Transfer in Spatial Log-Gaussian Cox Processes.

The doubly stochastic mechanism generating the realizations of spatial log-Gaussian Cox processes is empirically assessed in terms of generalized entropy, divergence and complexity measures. The aim is to characterize the contribution to stochasticity from the two phases involved, in relation to the transfer of information from the intensity field to the resulting point pattern, as well as regarding their marginal random structure. A number of scenarios are explored regarding the Matérn model for the covariance of the underlying log-intensity random field. Sensitivity with respect to varying values of the model parameters, as well as of the deformation parameters involved in the generalized informational measures, is analyzed on the basis of regular lattice partitionings. Both a marginal global assessment based on entropy and complexity measures, and a joint local assessment based on divergence and relative complexity measures, are addressed. A Poisson process and a log-Gaussian Cox process with white noise intensity, the first providing an upper bound for entropy, are considered as reference cases. Differences regarding the transfer of structural information from the intensity field to the subsequently generated point patterns, reflected by entropy, divergence and complexity estimates, are discussed according to the specifications considered. In particular, the magnitude of the decrease in marginal entropy estimates between the intensity random fields and the corresponding point patterns quantitatively discriminates the global effect of the additional source of variability involved in the second phase of the double stochasticity.

Surgical approach to prune-belly syndrome: A review of our series and novel surgical technique.

INTRODUCTION: Surgical management of children with Prune-belly syndrome (PBS) can be divided into three categories: urinary tract reconstruction, abdominal wall reconstruction, and orchidopexy. Adequate repair of the abdominal wall by abdominoplasty at an early age, allows an adequate aesthetic appearance, but also allows a correct development of walking, breathing, defecation and urination. OBJECTIVE: To present a novel surgical technique for abdominal wall reconstruction, which combines plication with complete overlap of the fascia and neoumbilicoplasty with an island flap rotated on itself. STUDY DESIGN: A retrospective review of the patients with PBS who underwent surgery in our center between 2009 and 2020. A new abdominoplasty technique was performed, which consists of plication with complete overlap of the fascia, as well as a neoumbilicoplasty with an island flap rotated on itself. The skin is then well freed from the rest of planes, and the plication is performed with complete overlapping of the muscle-aponeurotic plane from one side to the other. At this time, the interposition of some type of reinforcement material (mesh) may be required in the event of complete absence or insufficient presence of the fascia and muscle. RESULTS: Abdominoplasty was performed in four patients. In all patients, bilateral orchidopexy was performed in the same surgical procedure for intra-abdominal testicles. The mean age of the patients at the time of surgery was 10,5 years and the average admission time was 4 days. There were no short-term or long-term complications. Average follow-up time was 7 years. All patients and their families are satisfied with the aesthetic result obtained. DISCUSSSION: Abdominoplasty in patients with PBS in addition to aesthetic reconstruction, brings significant improvements to wandering, breathing, urination and defecation, improving the quality of life of the patient. Compared to the techniques described, the abdominoplasty we propose makes it possible to easily improve the abdominal wall support by means of meshes or synthetic devices if necessary and allows the evaluation and correction of cryptorchidism or other associated renal abnormalities in the same surgical act, as it allows full abdominal exposure. Likewise our modified abdominoplasty allows the creation of the new umbilicus in a more anatomical way, rectifying its natural position. CONCLUSION: In our experience, this modified surgical technique for abdominal wall repair is a novel procedure in the PBS approach, easily reproducible, which provides good aesthetic results in our series of cases.

Do High Levels of Maternally Derived Antibodies Interfere with the Vaccination of Piglets against Porcine Circovirus Type 2? A Literature Review and Data Analysis.

Vaccination against porcine circovirus type 2 (PCV2) is commonly performed in piglets worldwide, and increasingly also in sows. We conducted a literature search and review to assess the potential interference of maternally derived antibodies (MDA) in piglets with vaccination against PCV2. The effectiveness of vaccination was compared to no vaccination in the presence of high levels of MDA (≥8 log2 IPMA titer), as reported in field studies. In total, 13 papers fulfilled the predefined inclusion criteria, allowing up to 24 comparisons per parameter. In the presence of high levels of MDA, vaccinated pigs had, on average, a 20 g/d higher mean daily weight gain and a 34% lower mortality compared to non-vaccinates. The maximum percentage of viremic pigs was reduced by 63% and the maximum viral load in serum was 0.72 log10 PCV2 DNA copies lower. Vaccination at 3 weeks of age was associated with the highest improvements in production parameters and reductions in viremia. Our findings suggest that the vaccination of piglets is effective with respect to production parameters and viremia even in the presence of high MDA, with an age of 3 weeks at vaccination being most beneficial.

Probability of PRRS virus detection in pooled processing fluid samples.

There has been a tremendous increase in recent years of population-based diagnostic monitoring and surveillance strategies in swine populations. One example is the use of processing fluids (PF) to screen breeding herds for porcine reproductive and respiratory syndrome virus (PRRSV) activity. An important question from practitioners using such methods is on how intensively can the sample be pooled. More specifically, processing fluids of how many litters can be pooled into a single sample for diagnostic testing to preserve a high probability of PRRSV RNA detection at low prevalence situations? The objective of this study was to model the effect of pooling PF samples on the probability of PRRSV RNA detection. For this study, a PRRSV-positive PF field sample with a RT-rtPCR quantification cycle (Cq) value of 28 was selected to represent a litter of 11 pigs with a single viremic piglet. PF samples from a PRRSV-naïve herd were used to perform 6 replications of 8 two-fold serial dilutions of the PRRSV-positive sample, thus modeling the pooling effect (dilution). Each two-fold dilution represented an increase in the number of PRRS-negative pigs in the sample by a factor of 2. Samples were tested for PRRSV RNA by RT-rtPCR and the data was analyzed using linear and probit regression models. There was an average increment of 1.37 points in Ct for each two-fold dilution. The estimated probability of testing positive on RT-rtPCR was 43 %, 80 %, and 95 % when there was a single PRRSv-positive piglet among 784, 492, and 323 PRRSv-negative piglets contributing to the sample respectively. Results from this study support the practice of collecting and aggregating PF samples from multiple litters for PRRSV RNA testing.

Micro-Ureteroscopy as a Treatment of Renal Pelvis Lithiasis in Young Children.

Aim: Miniaturization of endoscopic instruments has allowed to improve the efficacy of kidney stone treatment in young children. Aim of the study is to evaluate the usefulness of microureteroscopy with 4.85F sheath in the treatment of renal stones in children. M&M: We present 4 cases of microureteroscopy in 3 younger than 3 years patients with renal pelvic stones. Lithiasis was unilateral in 2 female patients and bilateral in 1 male patient. Microureteroscopy was performed using a MicroPerc set 4.85F sheath, without placing a safety guide or dilating the meatus in 3 procedures. The lithotripter system used was Ho:YAG Laser with 200-µm fiber in all cases. Results: Mean operating time was 100 ± 16 min. There were no intraoperative complications. In all procedures, complete pulverization of the lithiasis was achieved, except in the coraliform lithiasis in which 5 mm residual lithiasis remained in the lower calyx. All patients were discharged 24 h after the intervention. Conclusion: Microureteroscopy can be considered a new alternative for treatment of selected cases of renal pelvic stones in infants and children.

Endourologic Treatment in Two Cases of Ureteral Valves.

Introduction: Congenital ureteral valves are a rare cause of ureteral obstruction that may lead to renal function deterioration. We present two clinical cases treated endoscopically by monopolar electrocautery and laser fiber ablation. Presentation of Case: The first case is a 13-year-old male with several episodes of abdominal pain and was found to have severe left hydronephrosis. Ultrasonography showed a dilated ureter and pelvicaliceal system with an obstructive renogram curve. We performed a retrograde pyelogram, finding a dilated ureter 5 cm up from the vesicoureteral junction with ureteral valves in that place. Ablation of the valves was conducted using monopolar electrocautery. The second case is a 2-year-old male with left ureterohydronephrosis shown in abdominal ultrasonography. In the radiologic findings, a high-risk pyelocaliceal dilatation with renal parenchyma thinning and a diameter of 3.3 cm for the left ureter is described, with an obstructive renogram. We performed a cystoscopy, observing the presence of valves in the ureter at 3 cm that conditioned an obstruction. The complete section of the valves was performed through a 270µm holmium laser fiber. Our patients made an uneventful postoperative recovery and continue to remain completely asymptomatic. A significant decrease in renal dilation was observed and renal function recovered in both cases. Conclusion: Ureteral valves are an uncommon cause of ureteral obstruction. Advances in endourologic techniques allow us to give a minimally invasive approach to these diseases, obtaining good long-term results in our small series of patients.

Micropercutaneous endopyelotomy for the treatment of secondary ureteropelvic junction obstruction in children.

INTRODUCTION: The management of recurrent pyeloureteral junction obstruction (PUJO) is controversial, as there is no suitable technique for its correction. Percutaneous endopyelotomy shows better results in recurrent PUJO compared to primary PUJO. Micro-percutaneous approaches reduce damage to renal parenchyma and facilitate access to renal pelvis. OBJETIVE: To present our experience in the use of this minimally invasive technique for the treatment of recurrent PUJO. STUDY DESIGN: A retrospective study was performed collecting data of patients with recurrent PUJO treated in our hospital using the percutaneous approach between July 2014 and January 2018. Micropercutaneous access was performed in all patients. In Valdivia position, a 5 or 6 mm high-pressure ballon is placed in the renal pelvis under cystoscopic and fluoroscopic guidance. The 4.8 or 8 Fr microperc puncture needle is placed into the pelvicalyceal system. Endopyelotomy is performed with a laser fiber or monopolar hook on a high-pressure balloon. To improve the exposure of the cutting area, the high-pressure balloon is placed at the pyeloureteral junction. Double J stent is left for weeks. RESULTS: The ages of the patients were 4, 8 and 18 months, and 2 and 4 years. All patients had previously undergone pyeloplasty due to pyeloureteral junction obstruction. Operative time was 50 ± 21 min. Hospital stay after surgery was 24 h and hematuria disappeared within the 24 postoperative hours. DISCUSSION: The number of patients with recurrent PUJO is small, making it difficult to establish a standard surgical approach for failed pyeloplasty. Redo pyeloplasty is considered the gold standard by some authors but alternative methods, such as endourological techniques, may also have a role in the treatment of failed pyeloplasty. The percutaneous approach has shown very good results in this treatment and the miniaturization of percutaneous surgery has improved with the micropercutaneus access. We consider micropercutaneous approach helped with a high pressure balloon in the pyeloureteral junction is an alternative and minimally invasive technique that has shown good results in our small cases series. However, we must take into account the limitation of the study considering the low number of patients. We need prospective studies to support our results. CONCLUSION: Micropercutaneous endopyelotomy is a fairly effective technique to treat recurrent UPJO after failed pyeloplasty in children. In our experience, it reduces kidney damage without increasing complications.

Faloplastia suprapública: nueva técnica quirúrgica para el pene enterrado / Suprapubic falloplasty: new surgical technique for the buried penis

INTRODUCCIÓN Y OBJETIVO: El pene enterrado es un motivo de consulta frecuente en la práctica clínica pediátrica. En general, los cuerpos cavernosos y el glande son normales, pero el pene está enterrado por el exceso de grasa suprapúbica, sin fijación de los ángulos peno-púbicos. Presentamos nuestra serie de pacientes intervenidos mediante una alternativa al tratamiento quirúrgico clásico. MATERIAL Y MÉTODO: Descripción de técnica quirúrgica, modificada en los últimos 10 años, que incluye Z-plastia suprapúbica para obtener suficiente piel para cubrir la base del pene, lipectomía suprapúbica y sección del ligamento suspensorio del pene con fijación de ángulos penopúbicos. Estudio retrospectivo de pacientes con recopilación de datos sobre edad, complicaciones y resultado estético obtenido. RESULTADOS: Fueron intervenidos 16 pacientes con edad media de 9 años. La técnica quirúrgica modificada se aplicó a todos los pacientes, retirando vendaje y sonda vesical a las 24 horas de la cirugía en todos los casos. Las complicaciones a corto plazo fueron: pérdida parcial del colgajo de la Z-plastia en 2 pacientes que curó por segunda intención; edema significativo de la mucosa prepucial en 6 pacientes. El seguimiento medio fue superior a 5 años en todos los casos. A largo plazo, tanto los pacientes como los padres mostraron satisfacción con los resultados. CONCLUSIONES: El abordaje quirúrgico del pene enterrado no está estandarizado y es un tema cuestionado. En nuestra experiencia, la intervención quirúrgica con abordaje suprapúbico en los pacientes con hipertrofia de grasa púbica aporta mejor aspecto estético, con menos recidivas a largo plazo y clara mejoría psicológica de los pacientes

BACKGROUND AND OBJECTIVE: Buried penis is a frequent claim in pediatric outpatient clinic. Usually the cavernous bodies and the gland are normal but the penis is buried in the excess suprapubic fat, with no fixation of the peno-pubic angles. We present our series of patients treated with an alternative to the classic surgical treatment. METHODS: Our surgical technique has been modified in the last 10 years to include a suprapubic Z-plasty in order to get enough skin to cover the base of the penis, lipectomy with section of the suspensory ligament of the penis and fixation of the penopubic angles. We conduct a retrospective study of our patients, collecting data about age, complications and aesthetic results. RESULTS: Sixteen patients with a mean age of 9 years were operated. The modified surgical technique was applied to all patients; bandage and bladder catheter were removed after 24 hours in all cases. Short-term complications were partial los of the Z-plasty flap that cured by secondary intention in 2 patients and in 6 patients a significant edema of the preputial mucosa was observed. Mean follow-up was longer than 5 years in all cases. At the end of follow-up, both patients and parents were satisfied with the results. CONCLUSION: The gold-standard surgical technique for the buried penis is still controversial. In our experience, the suprapubic approach in patients with pubic fat hypertrophy, provides better aesthetic appearance with fewer long-term relapses and a clear psychological impact

Systemic and local effects of lidocaine or mepivacaine when used for intravenous regional anaesthesia of the distal limb in standing sedated horses.

BACKGROUND: Local anaesthetics are being combined clinically with amikacin in intravenous regional limb perfusion (IVRLP), with limited knowledge on the analgesia provided and its onset and duration of action after tourniquet application and release. OBJECTIVE: To evaluate the systemic clinical effect, limb withdrawal to nociceptive stimulation, and plasma and synovial fluid concentrations after IVRLP with lidocaine or mepivacaine in standing sedated horses. STUDY DESIGN: Prospective, controlled, randomised, cross-over study. METHODS: Six healthy adult horses were sedated and received IVRLP with lidocaine, mepivacaine or saline (negative control), or perineural anaesthesia of the medial and lateral palmar and palmar metacarpal nerves (positive control) in one forelimb with a 3-week washout period between trials. Electrical and mechanical stimuli were used to test nociceptive threshold of the limb before and after IVRLP/perineural anaesthesia. For lidocaine and mepivacaine trials, blood was collected from the jugular vein and synovial fluid from the radiocarpal joint before, during and out to 24 hours after IVRLP. Drug concentrations were measured using high-performance liquid chromatography. RESULTS: Nociceptive thresholds for lidocaine, mepivacaine and perineural anaesthesia trials were significantly increased compared with saline and baseline values at 10, 20 and 30 minutes, with no differences between anaesthetic trials. During this time, horses had lower heart rates than IVRLP with saline. After tourniquet release at 30 minutes, nociceptive thresholds for lidocaine and mepivacaine trials gradually returned to baselines, whereas perineural anaesthesia trial remained unchanged out to an hour. Plasma lidocaine and mepivacaine concentrations were ≤50 ng/mL while the tourniquet was in place, significantly increasing 10 minutes after tourniquet release. Maximal lidocaine and mepivacaine concentrations in synovial fluid were reached 25 minutes after IVRLP injection. MAIN LIMITATIONS: Amikacin was not included in the perfusate. CONCLUSION: Similar to perineural anaesthesia, IVRLP with lidocaine or mepivacaine provides anti-nociception to the distal limb in standing sedated horses while a tourniquet is applied with concentrations remaining below toxic levels in plasma and synovial fluid.