La visita infantil a la unidad de cuidados intensivos pediátricos desde la experiencia de las enfermeras / Children's visits to the paediatric intensive care unit from the nurses’ experience

Objetivo Explorar la experiencia de las enfermeras en relación con la facilitación de la visita infantil a la UCIP. Método Estudio fenomenológico interpretativo mediante entrevistas en profundidad. El estudio se desarrolló en las UCIP de dos centros públicos madrileños de nivel IIIC. Participaron 12 enfermeras con experiencia mayor de dos años en UCIP que, en el momento de la entrevista, prestaban servicios en dichas unidades. Además, se entrevistó a una psicóloga con experiencia de cuatro años en UCIP cuya información se consideró en el contexto de los datos en la sombra. La información se analizó mediante un análisis temático del discurso. ResultadosLa experiencia de las enfermeras en relación a la facilitación de la visita infantil a la UCIP se puede condensar en cuatro temas: el emerger de la demanda, la preparación progresiva, la toma de decisiones desde el consenso y la creación de espacios de intimidad. Conclusiones Las experiencias de facilitación de la visita responden, principalmente, a la demanda de las familias que viven hospitalizaciones prologadas o al final de la vida. El rol de la enfermera es de acompañamiento reconociendo la labor prioritaria de los padres en la preparación de los niños y el desarrollo de la visita. Las enfermeras se sienten inseguras y faltas de recursos para el apoyo emocional y reclaman protocolos de actuación que orienten la intervención y toma de decisiones. (AU)

Aim To explore nurses’ experience related to promoting the visits of siblings to PICU. Methods An interpretative phenomenological study was carried out through in-depth interviews in two PICUs belonging to third level public hospitals in Madrid. Twelve nurses with more than two years of experience in PICU were interviewed. They all were working in PICU during the study. Furthermore, a PICU psychologist with an experience of four years was interviewed and this was considered shadowed data. Data analysis followed a thematic discourse analysis. Results Nurses’ experience of facilitating children's visits to PICU can be condensed into four themes: emerging demand for visits, progressive preparation, decision-making through common consensus and creating intimate spaces. Conclusions The experience of nurses in facilitating visits is mainly in response to the demand of families going through prolonged hospitalisation or end-of-life situations. The role of the nurse is one of accompaniment, recognising the major role of parents in the preparation of children and in developing the visit. Nurses feel insecure and lack resources for emotional support and demand action protocols to guide intervention and decision making. (AU)

Children's visits to the paediatric intensive care unit from the nurses' experience.

BACKGROUND: Family process disruption is one of the main consequences of the hospitalization of a critically ill child in a Paediatric Intensive Care Unit (PICU). Children's visits to PICU may help improve family coping. However, this is not standard practice and nurses' experiences in facilitating children's visits to units where it is encouraged is unknown. AIM: To explore nurses' experience related to promoting the visits of siblings to PICU. METHODS: An interpretative phenomenological study was carried out through in-depth interviews in two PICUs belonging to third level public hospitals in Madrid. Twelve nurses with more than two years of experience in PICU were interviewed. They were all were working in PICU during the study. Furthermore, a PICU psychologist with an experience of four years was interviewed and this was considered shadowed data. Data analysis followed a thematic discourse analysis. RESULTS: Nurses' experience of facilitating children's visits to PICU can be condensed into four themes: emerging demand for visits, progressive preparation, decision-making through common consensus and creating intimate spaces. CONCLUSIONS: The experience of nurses in facilitating visits is mainly in response to the demand of families going through prolonged hospitalisation or end-of-life situations. The role of the nurse is one of accompaniment, recognising the major role of parents in the preparation of children and in developing the visit. Nurses feel insecure and lack resources for emotional support and demand action protocols to guide intervention and decision making.

Cormorant Pellets as a Tool for the Knowledge of Parasite-intermediate Host Associations and Nematode Diversity in the Environment.

Anisakids are usually acquired through the diet. Cormorant pellets are useful to detect both parasite larval stages, and prey items which could act as intermediate hosts in the environment. The current study provides information about the feeding habits of both birds and mammals, and the diversity of parasites circulating in the environment. The objective of the study was to identify Anisakidae larvae and prey items in pellets from the Imperial shag Phalacrocorax atriceps and the Red-legged cormorant P. gaimardi, suggesting possible parasite-prey associations. A total of 92 P. atriceps' and 82 P. gaimardi's pellets were collected from both Punta León, and Isla Elena bird colonies, respectively, during the period from 2006 to 2010. Pellets were preserved in ethanol and hard prey item remnants, and nematode larvae were studied using standard techniques. Prey item occurrence, nematode prevalence, and mean intensity were calculated. A correspondence analysis was performed to evaluate the larvae-prey association. Contracaecum spp., Pseudoterranova spp,, Anisakis spp., Terranova spp., and Hysterothylacium spp. third-stage larvae (L3) were identifi ed in pellets. Pseudoterranova spp. and Anisakis spp. L3 predominated in the environment of Punta León, whereas Contracaecum spp. and Hysterothylacium spp. L3 predominated in the Puerto Deseado area. The highest larvae-prey association was that of Contracaecum spp. L3 with Engraulis anchoita, followed by with Odontestes sp. in P. atriceps' pellets. Contracaecum spp. L3 were significantly related to both sprats, Sprattus fueguensis and Ramnogaster arcuatta, in P. gaimardi's pellets. It was verifi ed that E. anchovy is the main gateway of Contracaecum spp. L3 in P. atriceps. Odonthestes sp. might act as an intermediate/paratenic host of Contracaecum spp. L3 in the area. Both sprats might play a role as intermediate/paratenic hosts of C. australe, being the main gateway into P. gaimardi in the area. Thus, pellet analysis can be postulated as a good tool for indicating parasite-host associations between anisakids, and the prey items which act as intermediate hosts.

Is Amphiorchis (Digenea: Spirorchiidae) an Exclusive Parasite of Sea Turtles?

The side-necked turtle Hydromedusa tectifera commonly inhabits the tributary streams of the Rio de La Plata and occasionally is found in brackish waters within the estuary of the Rio de La Plata. Few studies have been conducted on its parasitic fauna, especially in Argentina. In the present work Amphiorchis sp. is registered for the first time in a freshwater turtle, expanding the knowledge about the specifi city of the genus that until now was considered inhabiting only marine turtles.

A new species of Hedruris (Nematoda: Hedruridae) from freshwater turtles, its life cycle and biogeographic distribution of the genus.

We describe Hedruris dratini n. sp. (Nematoda, Hedruridae) from Hydromedusa tectifera and Phrynops hilarii in Argentina based on morphological and molecular characters. Also, we provide information about its life cycle. The new species differs from other species of the genus by possessing the excretory pore, nerve ring and deirids at equal distance from the anterior end. Additionally, H. dratini n. sp. has mammilated eggs and males possess nine pairs of caudal papillae. The subadults and adults of H. dratini n. sp and H. orestiae were characterized by sequencing the small subunit ribosomal DNA (18S). We present for the first time a life cycle of a species of Hedruris that includes an amphipod as intermediate host and a reptile as definitive host. Furthermore, we analysed the host and geographic distribution of all Hedruris species. Although the genus has a cosmopolitan distribution and parasitizes a great host diversity, the majority of species have a Gondwanian distribution, with amphibians being the preferred hosts.

Tattoo associated retinochoroiditis. / Retinocoroiditis asociada a tatuaje.

CLINICAL CASE: A young woman was referred to our offices with impairment of visual acuity after she received a third tattoo on her arm. Systemic medical and laboratory work-up were performed in order to exclude an infectious agent or inflammatory disease. A yellowish juxtafoveal lesion in left eye along with a plaque-like outer retinal disruption and focal pigmentary defects was assessed using multi-modal diagnostic imaging. DISCUSSION: Ophthalmologists treating uveitis should consider this uncommon association and question patients regarding tattoos and tattoo inflammation given the rise of subjects undergoing artistic tattooing.

Stomach nematodes of three sympatric species of anatid birds off the coast of Patagonia.

The present study focuses on the nematode community in the stomachs of three sympatric anatid bird species from the Central Patagonian coast, Argentina. The bird species include the Chubut steamer duck, Tachyeres leucocephalus, the crested duck, Lophonetta specularioides, and the black-necked swan, Cygnus melancoryphus. Up to 138 nematodes representing five species were recovered from 10 of the 13 ducks examined, with an overall prevalence of 77% and a mean intensity of 13.8. Nematodes isolated from the gizzard were Streptocara formosensis and Sciadiocara legendrei (Acuariidae) in T. leucocephalus, and Epomidiostomum vogelsangi (Amidostomatidae) in C. melancoryphus, whereas Echinuria uncinata (Acuariidae) and Tetrameres (Petrowimeres) fissispina (Tetrameriidae) were found in the proventiculus of L. specularioides. In particular, S. legendrei was registered for the first time in South America and T. leucocephalus, whereas T. fissispina represents a new record in Argentina and L. specularioides. Moreover, E. vogelsangi and E. uncinata were isolated in Patagonia for the first time. The birds studied herein are sympatric in their distribution, and two of them are syntopic breeders; however, they were infected with different parasite species. This situation could be partially due to their diet or their seasonal movements, or a combination of both. Despite the low number of hosts examined, this work enhances our knowledge about parasites from a frequently occurring group of birds on the Patagonian coast, a subject that has not been studied extensively in South America.

Morphological, molecular and phylogenetic analyses of the spirurid nematode Stegophorus macronectes (Johnston & Mawson, 1942).

Stegophorus macronectes (Johnston & Mawson, 1942) is a gastrointestinal parasite found in Antarctic seabirds. The original description of the species, which was based only on females, is poor and fragmented with some unclear diagnostic characters. This study provides new morphometric and molecular data on this previously poorly described parasite. Nuclear rDNA sequences (18S, 5.8S, 28S and internal transcribed spacer (ITS) regions) were isolated from S. macronectes specimens collected from the chinstrap penguin Pygoscelis antarctica Forster on Deception Island, Antarctica. Using 18S rDNA sequences, phylogenetic analyses (maximum likelihood, maximum parsimony and Bayesian inference) of the order Spirurida were performed to determine the phylogenetic location of this species. Primer pairs of the ITS regions were designed for genus-level identification of specimens, regardless of their cycle, as an alternative to coprological methods. The utility of this molecular method for identification of morphologically altered specimens is also discussed.

Multiple solutions and numerical analysis to the dynamic and stationary models coupling a delayed energy balance model involving latent heat and discontinuous albedo with a deep ocean.

We study a climatologically important interaction of two of the main components of the geophysical system by adding an energy balance model for the averaged atmospheric temperature as dynamic boundary condition to a diagnostic ocean model having an additional spatial dimension. In this work, we give deeper insight than previous papers in the literature, mainly with respect to the 1990 pioneering model by Watts and Morantine. We are taking into consideration the latent heat for the two phase ocean as well as a possible delayed term. Non-uniqueness for the initial boundary value problem, uniqueness under a non-degeneracy condition and the existence of multiple stationary solutions are proved here. These multiplicity results suggest that an S-shaped bifurcation diagram should be expected to occur in this class of models generalizing previous energy balance models. The numerical method applied to the model is based on a finite volume scheme with nonlinear weighted essentially non-oscillatory reconstruction and Runge-Kutta total variation diminishing for time integration.

Gastrointestinal parasites in Chinstrap Penguins from Deception Island, South Shetlands, Antarctica.

Knowledge about parasites of Antarctic birds is fragmented and scarce. The aim of this work is to contribute to the knowledge of gastrointestinal parasites of the Chinstrap Penguin (Pygoscelis antarctica) from Deception Island (South Shetlands, Antarctica). Gastrointestinal tracts of 64 fresh dead individuals (61 chicks and three adults) were collected from December 2006 to February 2009 and examined for macroparasites. Three adult parasite species were found: two Cestoda species (Parorchites zederi and Tetrabothrius pauliani) and one Nematoda species (Stegophorus macronectes). Also, immature acanthocephalans (Corynosoma sp.) were found in one penguin. The low parasite richness observed could be related to the stenophagic and pelagic diet of the host species. False negatives were found in coprological studies.

Parálisis diafragmática en el postoperatorio de cirugía cardiaca infantil / Diaphragmatic paralysis after pediatric cardiac surgery

Objetivo: Describir la frecuencia, morbimortalidad y tratamiento de la disfunción diafragmática (DD) en el postoperatorio de la cirugía cardiaca infantil. Pacientes y métodos: Serie de casos de DD identificados entre la población de niños intervenidos de cirugía cardiaca en el hospital «12 de Octubre» de Madrid, entre 1997 y 2006. Se obtuvieron retrospectivamente datos demográficos, de la cirugía y del postoperatorio, así como de la estancia hospitalaria yde la morbimortalidad. Resultados: Cirugía cardiaca en 1.063 niños, diagnosticándose 23 casos de DD. Se excluyó un caso secundario a neuropatía generalizada. La frecuencia global fue del 2,1%. La mediana de edad fue de 14 días (1 día-16 meses), siendo 20 de los casos menores de 1 año. Se realizó plicatura en 13 pacientes (62%). Las indicaciones de plicatura fueron: fracaso de extubación (n= 11) y dificultad respiratoria persistente (n= 2).Fue preciso realizar plicatura quirúrgica en 9 de los 13 neonatos. El tiempo de ventilación mecánica invasiva, estancia en unidad de cuidados intensivos pediátricos (UCIP) y estancia hospitalaria en los casos con paresia fue de 8, 12 y 20 días(mediana), respectivamente. Las parálisis precisaron mayor tiempo de ventilación invasiva y de ingreso (19, 34 y 47,5 días). Conclusiones: A todo neonato intervenido de una cardiopatía compleja debería realizársele una ecografía diafragmática en respiración espontánea previa a su extubación, para así establecer el diagnóstico de manera precoz, con el objetivo de reducir el tiempo de ventilación mecánica y la morbilidad asociada (AU)

The objective of this study is to describe the frequency, morbimortality and treatment of diaphragmatic dysfunction (DD) after pediatric cardiac surgery. Patients and methods: Series of DD cases identified among the population of children who underwent cardiac surgery at the hospital 12 de Octubre of Madrid from the years 1997-2006. Demographic, surgical and postsurgical data have been obtained retrospectively, as well as data on hospital stay and the morbimortality. Results: A total of 1,063 children underwent cardiac surgery, diagnosing 23 DD cases. A secondary case was excluded due to generalized neuropathy. The global frequency was of 2.1%,the mean age was 14 days (1 d-16 m), being 20 of the cases under 1 year of age. Reefing was performed in 13 patients (62%). The indications for reefing were due to extubation failure (n= 11) and persistent respiratory difficulties (n= 2).Surgical reefing had to be performed in 9 from the 13 newborns. In the cases of paresis the length of the invasive mechanical ventilation, stay at the PICU and hospital stay was 8,12 and 20 days (mean) respectively. The paralysis required alonger time of invasive ventilation and hospitalization (19, 34 and 47,5 days).Conclusions: A diaphragm echography in spontaneous breathing should be performed on any newborn that underwent a complex cardiopathy surgery previous to the extubation in order to determine an early diagnosis and to reduce the length of mechanical ventilation and associated morbidity (AU)

[Chylothorax: experience in a paediatric intensive care unit]. / Quilotórax: experiencia en una unidad de cuidados intensivos pediátricos.

INTRODUCTION: Chylothorax is a fairly common condition seen in paediatric intensive care units, since it usually appears in the postoperative care of cardiothoracic surgery. Nevertheless, there is still uncertainty on the most effective treatment option and the prognostic factors for a positive response. OBJECTIVES: To describe our experience in the management of patients with chylothorax admitted to our paediatric intensive care unit (PICU). To look for prognostic factors for a response to the different treatments. MATERIAL AND METHOD: This is a descriptive and analytical, retrospective study, that includes the period 2000-2007. All cases of chylothorax of any aetiology diagnosed during this period in our PICU were included (excluding congenital neonatal cases). Demographic variables, aetiology, evolution of the debit, complications, type of treatment with results and side effects were recorded, along with the clinical progress. The possible relationship between the different variables (age, aetiology, debit), and progress, as well as response to treatments was analysed. RESULTS: A total of 24 patients, 12 males and 12 females, were included, of which 70.8% (17) were under 1 year of age. A total of 79.2% (19) were in postoperative care after surgery for a congenital heart disease. The most notable complications were sepsis (3/24 cases, 12.5%), hypoalbuminaemia (3/24, 12.5%), haemodynamic changes (2/24, 8.3%) and catheter-associated sepsis (2/16, 12.5%). The treatment with fat-free or rich in medium chain triglycerides diet was effective in 9/21 cases (43%) and total parenteral nutrition in 3/5 (60%), as opposed to the infusion of somatostatin in 8/11 (73%), used in second or third line. Somatostatin side effects were hypoglycaemia, hyperglycaemia and digestive disturbances, one patient in each case, and not causing complications. We did not find prognostic factors as regards progression or for the response to the different treatments. CONCLUSIONS: Sepsis, hypoalbuminaemia and haemodynamic disturbances were found to be complications associated to chylothorax. The treatment with somatostatin did not produce severe side effects, and there was a positive response in 73% of those treated with it.

Quilotórax: experiencia en una unidad de cuidados intensivos pediátricos / Chylothorax: experience in a paediatric intensive care unit

Introducción: en la experiencia clínica en cuidados intensivos pediátricos es relativamente frecuente encontrar quilotórax, dado que suele aparecer en el postoperatorio de cirugías cardiotorácicas. Sin embargo, todavía hay incertidumbre acerca de su tratamiento en cuanto a la elección de las distintas opciones terapéuticas, su eficacia y factores pronósticos para una respuesta positiva. Objetivos: describir nuestra experiencia en el manejo de los pacientes con quilotórax ingresados en una unidad de cuidados intensivos pediátricos. Buscar factores pronósticos de respuesta a los diversos tratamientos. Material y método: se trata de un estudio descriptivo y analítico, retrospectivo, que abarca el periodo 2000–2007. Se incluyeron los casos de quilotórax pediátrico de cualquier etiología atendidos en dicho periodo en nuestra unidad (excluidos casos neonatales congénitos). Se registraron variables demográficas, etiología, evolución del débito, complicaciones, tipo de tratamiento con resultado y efectos secundarios y evolución clínica. Se analizó estadísticamente la posible relación entre diversas variables (edad, etiología, débito) y la evolución y la respuesta a tratamientos. Resultados: se recogió un total de 24 pacientes, la mitad de cada sexo. Un 70,8% (17) eran menores de 1 año. El 79,2% (19) se encontraban en el postoperatorio de una cirugía por cardiopatía congénita. Las complicaciones más destacables fueron sepsis (3/24 casos, 12,5%), hipoalbuminemia (3/24, 12,5%), alteración hemodinámica (2/24, 8,3%) y sepsis por catéter (2/16, 12,5%). El tratamiento con dieta exenta en grasas o rica en ácidos grasos de cadena media fue eficaz en 9/21 casos (43%) y la nutrición parenteral total en 3/5 (60%), frente a la perfusión de somatostatina en 8/11 (73%), usada como segunda o tercera elección. Los efectos secundarios en relación con ella fueron hipoglucemia, hiperglucemia y molestias digestivas, un paciente en cada caso, y no causaron complicaciones. No se encontraron factores pronósticos de la evolución ni de la respuesta a los diversos tratamientos. Conclusiones: encontramos pacientes con sepsis, hipoalbuminemia y trastornos hemodinámicos como complicaciones relacionadas con el quilotórax. El tratamiento con somatostatina no presentó complicaciones graves y en un 73% de los pacientes tratados se produjo curación del quilotórax (AU)

Introduction: Chylothorax is a fairly common condition seen in paediatric intensive care units, since it usually appears in the postoperative care of cardiothoracic surgery. Nevertheless, there is still uncertainty on the most effective treatment option and the prognostic factors for a positive response. Objectives: To describe our experience in the management of patients with chylothorax admitted to our paediatric intensive care unit (PICU). To look for prognostic factors for a response to the different treatments. Material and method: This is a descriptive and analytical, retrospective study, that includes the period 2000–2007. All cases of chylothorax of any aetiology diagnosed during this period in our PICU were included (excluding congenital neonatal cases). Demographic variables, aetiology, evolution of the debit, complications, type of treatment with results and side effects were recorded, along with the clinical progress. The possible relationship between the different variables (age, aetiology, debit), and progress, as well as response to treatments was analysed. Results: A total of 24 patients, 12 males and 12 females, were included, of which 70.8% (17) were under 1 year of age. A total of 79.2% (19) were in postoperative care after surgery for a congenital heart disease. The most notable complications were sepsis (3/24 cases, 12.5%), hypoalbuminaemia (3/24, 12.5%), haemodynamic changes (2/24, 8.3%) and catheter-associated sepsis (2/16, 12.5%). The treatment with fat-free or rich in medium chain triglycerides diet was effective in 9/21 cases (43%) and total parenteral nutrition in 3/5 (60%), as opposed to the infusion of somatostatin in 8/11 (73%), used in second or third line. Somatostatin side effects were hypoglycaemia, hyperglycaemia and digestive disturbances, one patient in each case, and not causing complications. We did not find prognostic factors as regards progression or for the response to the different treatments. Conclusions: Sepsis, hypoalbuminaemia and haemodynamic disturbances were found to be complications associated to chylothorax. The treatment with somatostatin did not produce severe side effects, and there was a positive response in 73% of those treated with it (AU)

Hemorragia digestiva masiva por fistulización al esófago de una colateral aortopulmonar / Massive digestive system haemorrhage due to the formation of oesophageal fistulas of the aortopulmonary collateral arter

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[Diurnal variability of intraocular pressure]. / Variabilidad diurna de la presión intraocular.

OBJECTIVE: To assess whether there are variations in the intraocular pressure (IOP) between the morning and afternoon in healthy subjects. METHODS: This study was carried out in a Primary Care Health Center among usual patients of general practitioners. Two measurements of the intraocular pressure were assessed on the same day (between 8 and 9 a.m. and between 5 and 6 p.m.) using a Perkins applanation tonometer. The subjects (119 females and 101 males) had a mean age of 46.3 years, with ages ranging between 14 and 83 years. They were proportionally distributed among 4 age groups (14-24, 25-44, 45-64 and >65 years). RESULTS: The IOP mean values were: right eye, morning time and afternoon, 13.29 and 11.81 mm Hg, respectively (p<0.001); left eye, morning time and afternoon, 13.48 and 12.04 mm Hg (p<0.001). The IOP was significantly higher in males than in females, and showed a weak association with age. CONCLUSIONS: We found a diurnal variation of IOP of approximately 1.5 mm Hg. The time of day when the IOP is measured needs to be considered as a variable in research in ocular hypertension and glaucoma.

Estudio comparativo de la eficacia quirúrgica en la prostatectomía abierta y laparoscópica: reconstrucción virtual de la próstata y cuantificación del tejido periprostático / Comparative study of surgical efficacy in open versus laparoscopic prostatectomy: virtual prostate reconstruction and periprostatic tissue quantification

Introducción: La introducción de la cirugía laparoscópica como medio de realizar la prostatectomía radical precisa de un método objetivo para evaluar la idoneidad de este nuevo procedimiento quirúrgico. Los parámetros tradicionales, incluidos la incidencia de márgenes quirúrgicos positivos, son útiles, pero no suficientemente objetivos. Diferentes autores publican distintos criterios para definir los márgenes quirúrgicos positivos. Además, existen algunos artefactos técnicos que pueden ocurrir durante el procesamiento de la pieza quirúrgica por el patólogo, los cuales pueden dar lugar a márgenes falsamente positivos. Hemos usado un programa de modelización por ordenador acoplado al escaneado de las imágenes seriadas de cortes histológicos de la glándula completa, con el fin de determinar el porcentaje del tejido extracapsular que rodea a las glándulas prostáticas, tanto las extirpadas mediante la técnica abierta retropúbica como las extirpadas mediante laparoscopia. Este porcentaje puede considerarse un parámetro objetivo que potencialmente pueda predecir el beneficio de la cirugía en cuanto al control del cáncer, así como el éxito clínico del procedimiento quirúrgico. La correlación con los resultados clínicos a largo plazo, - supervivencia y recidiva bioquímica -servirán para validar en última instancia la utilidad clínica de este parámetro en años venideros. Materiales y métodos: Para este estudio se dispuso de un total de 32 piezas quirúrgicas de la próstata, incluidas 15 piezas de próstata de pacientes sometidos a prostatectomía radical abierta y 17 piezas de próstata de pacientes sometidos a prostatectomía laparoscópica. Después de la cirugía y de 24 horas de fijación en formol, se tomaron cortes seriados para realizar secciones completas (“whole mount”) de la próstata a intervalos de 5 mm de grosor. Un patólogo experto en uropatología revisó las secciones completas y dibujó los contornos de la cápsula prostática y del tumor en cada corte tisular. Las imágenes seriadas de la glándula completa y del tejido peri o extraprostático circundante se escanearon para producir imágenes digitales, utilizándose un programa informático para crear un archivo con información sobre la cápsula y un archivo con información sobre el tejido fibroadiposo circundante (extraprostático). Estos procedimientos permitieron la reconstrucción de un modelo tisular tridimensional de la cápsula prostática y del tejido extraprostático circundante. Se generaron dos archivos de nubes de puntos por separado, con la intención de representar modelos tanto de la cápsula como del tejido extraprostático y se usaron algoritmos de software para generar diferencias en las nubes de puntos y, de este modo, cuantificar la magnitud de la cobertura del tejido extracapsular, un parámetro que consideramos indicativo de la idoneidad de la técnica quirúrgica. Resultados: El porcentaje global de superficie de la glándula prostática cubierto por tejido fibroadiposo extracapsular fue estadísticamente mayor en las piezas extirpadas mediante la técnica laparoscópica, en comparación con la técnica retropúbica. Cuando se evaluó un análisis segmentario del porcentaje de cobertura de la glándula, se encontró que el porcentaje era significativamente mayor en los segmentos apical e inferolateral de las glándulas extirpadas sin preservación de los nervios y en el segmento apical de las glándulas extirpadas con preservación de los nervios para la prostatectomía laparoscópica. Conclusiones: En nuestra serie, la prostatectomía laparoscópica aportó una cobertura tisular extracapsular superior a la prostatectomía retropúbica. Del mismo modo, la prostatectomía laparoscópica aportó una cobertura tisular superior en las regiones inferolateral y apical de las glándulas extirpadas sin preservación de los nervios y en la región apical de las glándulas extirpadas con preservación de los nervios. Así pues, la idoneidad quirúrgica de esta técnica, en comparación con el procedimiento retropúbico, parece ser superior

Introduction: The introduction of laparoscopic surgery as a procedure to perform radical prostatectomy needs an objective method to evaluate the suitability of this new surgical procedure. The traditional parameters, including the incidence of positive surgical margins, are useful, but not sufficiently objective. Different authors publish different criteria to define positive surgical margins. In addition, there are some technical problems that may ocur during the processing of the surgical specimen by the pathologist, which can give false positive margins. We have used a computer modeling software in connection to scanned images from serial sections of the whole gland, to determine the percentage of extracapsular tissue that surrounds the prostate glands, removed by both, open retropubic and laparoscopic procedures. This percentage can be considered as an objective parameter which can potentially predict the benefit of surgery in predicting cancer control, as well as the clinical success of the surgical procedure. The correlation with the clinical results in the long term, survival and biochemical recurrence, will be useful to validate as a last resort the clinical utility of this parameter in the coming years. Materials and Methods: We had a total of 32 prostate surgical specimens, 15 from patients who underwent open retropubic prostatectomy and 17 from patients who underwent laparoscopic prostatectomy for this study. After surgery and 24 hours formol fixation, serial cuts were taken at 5 mm thickness intervals to make complete sections (“whole mount”) of the prostate. An expert uropathologist reviewed all the surgical sections and drew in each tissue cut the prostatic capsule and tumor contours. The serial images of the whole gland and surrounding prostate tissue were scanned to produce digital images, using a computer software to create a file with capsule information and a file with information on the surrounding fibroadipose tissue (extraprostatic). These procedures allowed the reconstruction of a threedimensional tissue model of the prostatic capsule and the surrounding extraprostatic tissue. Two separate point clouds files were generated, with the purpose of representing capsule and extraprostatic tissue models and software algorithms were used to generate differences in point clouds and thereby quantifying the extracapsular tissue coverage dimension, a parameter that we considered indicative of the adequeacy and feasibility of the surgical procedure. Results: The global percentage of prostate gland surface covered by extracapsular fibroadipose tissue was statistically higher in specimens removed by a laparoscopic procedure when compared to the open retropubic procedure. When a segmental analysis of the gland percentage of coverage was evaluated, it was found this percentage was significantly higher in the apical and inferolateral segments of those glands removed without nerves preservation and in the apical segments of those glands removed with nerves preservation for the laparoscopic prostatectomy. Conclusions: In our series, laparoscopic prostatectomy contributed superior extracapsular tissue coverage than retropubic prostatectomy. Similarly laparoscopic prostatectomy produced a superior tissue coverage in inferolateral and apical regions on those glands removed without nerve preservation and in the apical regions of those glands removed with nerve preservation

Síndrome de «shock» tóxico: a propósito de dos casos / Toxic shock syndrome: a report of two cases

Los síndromes de shock tóxico y shock similar a tóxico son entidades causadas por superantígenos que ponen en marcha una respuesta sistémica que determina sus características clínicas. Exponemos dos casos detectados en nuestro hospital que cumplen los criterios diagnósticos de síndrome de shock tóxico al presentar una temperatura ³38,9 ºC, un exantema con posterior descamación, una hipotensión arterial y una afectación de 3 o más órganos. El primero evolucionó hacia un fallo multiorgánico con cultivos negativos, por lo que se diagnosticó de etiología probablemente estafilocócica. El paciente experimentó un deterioro progresivo, sin respuesta a las medidas de soporte, y falleció. El segundo caso se manifestó como una fascitis necrosante de la pared abdominal, que precisó un desbridamiento quirúrgico. El crecimiento de Streptococcus pyogenes se detectó en la faringe y en el exudado de la herida quirúrgica. Su evolución fue favorable, por lo que recibió el alta con una estenosis traqueal como única secuela. Los dos casos demuestran la importancia de la sospecha clínica en estos cuadros para pautar el tratamiento antibiótico e instaurar una terapia de soporte con rapidez

Toxic shock syndrome and toxic shock-like syndrome are diseases caused by superantigens that trigger a systemic inflammatory response, which is responsible for the clinical manifestations. We report two cases treated at our institution that meet the diagnostic criteria for toxic shock syndrome: body temperature ³38.9 ºC, rash with subsequent desquamation, hypotension and involvement of three or more organ systems. The first patient developed multisystem failure with negative cultures, suggesting a probable staphylococcal etiology. The patient experienced a progressive deterioration with no response to supportive care, and finally died. The second case presented as necrotising fasciitis of the abdominal wall, requiring surgical debridement. Streptococcus pyogenes was grown in the samples obtained from the pharynx and from the surgical wound. This patient had a favorable clinical course with tracheal stenosis as the only sequela at the discharge from hospital. High clinical suspicion is extremely important in this syndrome for the early initiation of antibiotic therapy and intensive care