Propiedades de la manteca de bufeo, del chuchuhuasi, el cocobolo, la clabohuasca, la huacapuruna, el ipururo y el viborachado: afrodisiacos populares peruanos en Pantaleón y las visitadoras, de Mario Vargas Llosa / Properties of bufeo butter, chuchuhuasi, cocobolo, clabohuasca, huacapuruna, ipururo and viborachado: popular Peruvian aphrodisiacs in Captain Pantoja and the special services, by Mario Vargas Llosa

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Minimally invasive retrieval of a retained Jackson--Pratt drainage tube using the Sachse urethrotome.

OBJECTIVE: A retained postoperative drain tube, trapped by one or more of the sutures of the abdominal wall closure, is a rare complication of frustrating consequences and potential legal repercussions. There are few reports of techniques for minimally invasive removal of an anchored postoperative drain tube, which not infrequently has been treated by reopening the wound. METHOD/RESULT: A 75 years-old man with a left T2-T3N0M0 renal carcinoma was treated with transperitoneal laparoscopic nephrectomy and a Jackson-Pratt drain was left in place. Drain removal the day after revealed impossible, as if being caught with fascial suture. With the patient under sedation, we introduced a Sachse urethrotome parallel to the drain, and the abdominal fascia was identified, then the polyglycolic stitch anchoring it to the wall could be severed, freeing the drain. CONCLUSIONS: Percutaneous extraction with the Sachse urethrotome of an anchored postoperative drain, should be the first option, before trying a forced traction or using more complex options. This technique is for the first time published in the Spanish bibliography, and we think this possibility should be disclosed to abdominal surgeons.

Retirada mínimamente invasiva con el uretromo de Sasche de un drenaje de Jackson-Pratt retenido / Minimally invasive retrieval of a retained Jackson - Pratt drainage tube using the sachse urethrotome

OBJETIVO: La retención de un drenaje postoperatorio, atrapado por una o más de las suturas del cierre de la pared abdominal, es una complicación infrecuente, de consecuencias frustantes y potenciales repercusiones legales. Existen en la bibliografía pocos informes de técnicas para la retirada poco invasiva de un drenaje postquirúrgico anclado, que en no pocas ocasiones se ha tratado mediante la reapertura de la herida. Un varón de 75 años con un carcinoma renal izquierdo T2-T3 N0 M0 fue tratado mediante una nefrectomía laparoscópica intraperitoneal y se dejó implantado un drenaje de Jackson-Pratt. A las 24 horas se puso de manifiesto que la retirada del drenaje era imposible por encontrarse atrapado con la sutura fascial. MÉTODO/RESULTADO: Con el paciente bajo sedación, se introdujo un uretrotomo de Sachse paralelamente al drenaje y se identificó primero la aponeurosis abdominal y a continuación el punto de poliglicólico que lo anclaba a la pared, y que pudo ser seccionado, liberando el drenaje. CONCLUSIONES: La extracción percutánea, mediante el uretrotomo de Sachse, de un drenaje de Jackson-Pratt anclado, debería ser la primera opción, antes de probar una tracción forzada o de recurrir a opciones más complejas. Es la primera vez que se publicita esta técnica en la bibliografía española, y esta posibilidad debería ser divulgada entre los cirujanos abdominales(AU)

OBJECTIVE: A retained postoperative drain tube, trapped by one or more of the sutures of the abdominal wall closure, is a rare complication of frustrating consequences and potential legal repercussions. There are few reports of techniques for minimally invasive removal of an anchored postoperative drain tube, which not infrequently has been treated by reopening the wound. METHOD/RESULT: A 75 years-old man with a left T2-T3N0M0 renal carcinoma was treated with transperitoneal laparoscopic nephrectomy and a Jackson-Pratt drain was left in place. Drain removal the day after revealed impossible, as if being caught with fascial suture. With the patient under sedation, we introduced a Sachse urethrotome parallel to the drain, and the abdominal fascia was identified, then the polyglycolic stitch anchoring it to the wall could be severed, freeing the drain. CONCLUSIONS: Percutaneous extraction with the Sachse urethrotome of an anchored postoperative drain, should be the first option, before trying a forced traction or using more complex options. This technique is for the first time published in the Spanish bibliography, and we think this possibility should be disclosed to abdominal surgeons(AU)

[Knowledge of the urogenital diseases in the work of Gaspar Casal, "natural and medical history of the Principality of Asturias" (1762)]. / Conocimiento de las enfermedades urogenitales en la obra de Gaspar Casal, "Historia natural y medica del Principado de Asturias" (1762).

OBJECTIVES: Gaspar Casal (Gerona, 1680, Madrid, 1759) made most of his medical work in Oviedo (Asturias, Spain), where he lived for thirty-four years, before his return to Madrid as a doctor for the Royal House. Fruits of this work is the book "Natural and medical history of the Principality of Asturias" (Madrid, 1762), considered the best exponent of the Spanish medicine of the 18th century, and where the "disease of the rose", known later as pellagra or hypovitaminosis B, was first described in. METHODS: Study of the life of Gaspar Casal and analysis of "Natural and medical history of the Principality of Asturias", speculating on the knowledge about nephro-urologic and external genitalia diseases that can be deduced from the text. RESULTS: Casal knows and treats kidney lithiasis, relating it either to joint diseases and gout, or to dietetic excess and sedentary life in some of his patients. Other diseases coursing with poliuria and oedemas, are compatible with the nowadays diagnosis of infectious or degenerative nephritis. He rarely uses a bladder catheter for cases of stranguria and anuria, probably including some patients with anuria and others with urinary retention in the term "renal ischuria or high suppression", although he also uses the term "vesical ischuria" for the last ones. He treats the symptoms disuria-stranguria and haematuria, with empiric therapy, and, as it may be deduced from the text, some local surgeons didn't use or know to alleviate those symptoms with urethral catheterisation. He attends an epidemics of mumps, with orchitis in male patients, that were treated with bloodletting, although he stood against the misuse of phlebotomy in several diseases. Only occasionally he orders surgical treatment for several testis diseases. CONCLUSIONS: "Natural and medical history of the Principality of Asturias" reflects the spectrum of diseases that conforms the day-to-day working schedule of a Spanish family doctor in the beginning of the 18th century, that is to say: diseases resulting from dietary shortage, infective, parasite, degenerative and vascular-cerebral diseases in older patients. From the nephro-urologic point of view, it is very interesting to read about the knowledge on stone diseases and lower urinary tract symptoms, that were treated as recommended by the classic authors, with physical therapy and empiric formulas, rarely with bladder catheterization. To a lesser degree, the results of the medical treatment of orchitis and the surgical treatment of some testis diseases are also depicted.

Conocimiento de las enfermedades urogenitales en la obra de Gaspar Casal, «Historia natural y médica del Principado de Asturias» (1762) / Knowledge of the urogenital diseases in the work of Gaspar Casal, «natural and medical history of the Principality of Asturias» (1782)

OBJETIVO: Gaspar Casal (Gerona 1680, Madrid 1759) realiza la mayor parte de su obra médica en Oviedo, donde vive treinta y cuatro años, antes de volver a Madrid como médico de la Real Cámara. Fruto de su trabajo en Asturias es el libro póstumo «Historia natural y médica del Principado de Asturias» (Madrid, 1762), considerado el mejor exponente de la medicina española del siglo XVIII, y donde se describe por primera vez el «mal de la rosa», más tarde llamada pelagra o avitaminosis B. MÉTODOS: Estudio de la vida de Gaspar Casal y análisis de su única obra «Historia natural y médica del Principado de Asturias», especulando sobre el conocimiento de las enfermedades nefro-urológicas y genitales que se deduce de este texto. RESULTADOS: Casal conoce y trata la litiasis renal, que relaciona en unas ocasiones con las dolencias articulares y la gota, y en otras con la abundancia de comida y la vida sedentaria. Otras enfermedades acompañadas de poliuria y edemas que describe, son compatibles con el diagnóstico actual de nefritis infecciosa o degenerativa. Utiliza en pocas ocasiones el sondaje vesical en los casos de estranguria y anuria, incluye posiblemente en el término de «iscuria renal o supresión alta» a algunos enfermos con anuria y a otros con retención de orina, aunque también usa el término «iscuria vesical» para estos últimos. Los síntomas disuria-estranguria y hematuria, los trata sólo con terapia empírica, y se intuye en su texto que para los cirujanos locales no era habitual el alivio de estos síntomas mediante el sondaje uretral. Atiende una epidemia de paperas, con orquitis en los varones, que trata mediante sangrías, aunque se mostró contrario al abuso de las mismas. Sólo ocasionalmente hace tratar quirúrgicamente ciertas enfermedades testiculares. CONCLUSIONES: «Historia natural y médica del Principado de Asturias» refleja el espectro de las enfermedades que en la primera mitad del siglo XVIII ocupaban el trabajo de un médico, a saber, las derivadas de las carencias alimentarias, infecciosas, parasitarias y las degenerativas y vásculo-cerebrales en personas añosas. Desde el punto de vista nefro-urológico, es muy interesante comprobar el conocimiento en esa época de la enfermedad litiásica y de los síntomas del tramo urinario inferior, tratados al modo recomendado por los clásicos, con tratamiento físico y preparados empíricos, pocas veces con sondaje; y, en menor medida, los resultados del tratamiento médico de las orquitis y el tratamiento quirúrgico de algunas lesiones testiculares (AU)

OBJECTIVES: Gaspar Casal (Gerona, 1680, Madrid, 1759) made most of his medical work in Oviedo (Asturias, Spain), where he lived for thirty-four years, before his return to Madrid as a doctor for the Royal House. Fruits of this work is the book «Natural and medical history of the Principality of Asturias» (Madrid, 1762), considered the best exponent of the Spanish medicine of the 18th century, and where the «disease of the rose», known later as pellagra or hypovitaminosis B, was first described in. METHODS: Study of the life of Gaspar Casal and analysis of «Natural and medical history of the Principality of Asturias», speculating on the knowledge about nephro-urologic and external genitalia diseases that can be deduced from the text. RESULTS: Casal knows and treats kidney lithiasis, relating it either to joint diseases and gout, or to dietetic excess and sedentary life in some of his patients. Other diseases coursing with poliuria and oedemas, are compatible with the nowadays diagnosis of infectious or degenerative nephritis. He rarely uses a bladder catheter for cases of stranguria and anuria, probably including some patients with anuria and others with urinary retention in the term «renal ischuria or high suppression», although he also uses the term «vesical ischuria» for the last ones. He treats the symptoms disuria-stranguria and haematuria, with empiric therapy, and, as it may be deduced from the text, some local surgeons didn't use or know to alleviate those symptoms with urethral catheterisation. He attends an epidemics of mumps, with orchitis in male patients, that were treated with bloodletting, although he stood against the misuse of phlebotomy in several diseases. Only occasionally he orders surgical treatment for several testis diseases. CONCLUSIONS: «Natural and medical history of the Principality of Asturias» reflects the spectrum of diseases that conforms the day-to-day working schedule of a Spanish family doctor in the beginning of the 18th century, that is to say: diseases resulting from dietary shortage, infective, parasite, degenerative and vascular-cerebral diseases in older patients. From the nephro-urologic point of view, it is very interesting to read about the knowledge on stone diseases and lower urinary tract symptoms, that were treated as recommendedby the classic authors, with physical therapy and empiric formulas, rarely with bladder catheterization. To a lesser degree, the results of the medical treatment of orchitis and the surgical treatment of some testis diseases are also depicted (AU)

[Secondary bladder amylodosis with severe recurrent hematuria: transurethral Mikuliz procedure as hemostatic option]. / Hematuria grave recidivante por amiloidosis vesical secundaria. Mikulicz transuretral como opción hemostática.

OBJECTIVES: Primary localized amyloidosis of the urinary bladder generally has a benign course. On the contrary, secondary amyloidosis, a consequence of systemic amyloidosis, may have massive bleeding and produce complications such as bladder rupture or lifethreatening hemodynamic problems requiring desperate hemostatic procedures such as hypogastric artery embolization or ligature, or cystectomy. We report one case in which hemostasis was achieved by a Mickulicz transurethral bladder tamponage. METHODS: 58 year old female with very aggressive rheumatoid arthritis and secondary renal amyloidosis under chronic hemodialysis presenting with severe hematuria after hip replacement. An inflamed bladder was found, the biopsy of which showed edema in all layers with blood vessel walls enlarged by amiloyd deposits. After several unsuccessful transurethral hemostatic procedures, intravesical formalin irrigation was carried out together with a Mikulicz type gauze packaging after urethral dilation. The gauze was withdrawn three days later without bleeding recurrence; however she presented subsequent neurological impairment and finally died 14 days after the last urological procedure. CONCLUSIONS: Transurethral packaging of the urinary bladder in a woman with massive hematuria is a hemostatic option that we recommend to be used before other more dramatic or invasive options are chosen.

Hematuria grave recidivante por amiloidosis vesical secundaria. Mikuliz transuretral como opción hemostática / Secondary bladder amyloidosis with severe recurrent hematuria: transurethral Mikuliz procedure as hemostatic option

OBJETIVO: Al contrario que la amiloidosisvesical primaria o localizada, cuyo curso es generalmentebenigno, en la forma secundaria, consecuenciade amiloidosis sistémica, el sangrado puede sermasivo, con necesidad de procedimientos hemostáticosdesesperados como la ligadura de las arterias hipogástricaso la cistectomía. Describimos un caso en elque la hemostasia se logró mediante un taponamientovesical transuretral de tipo Mikulicz.MÉTODO Y RESULTADO: Una mujer de 58 años conartritis reumatoide muy agresiva, amiloidosis renalsecundaria y en hemodiálisis crónica, presentabahematuria grave después de haber sido operada de lacadera . Se le encontró una vejiga inflamatoria en cuyabiopsia, todas las capas estaban edematizadas y lasparedes de los vasos engrosadas por depósitos deamiloide. Después de varios procedimientos hemostáticostransuretrales infructuosos, se realizó una formolización vesical, y un taponamiento endovesical de tipoMikulicz con vendas de gasa introducidas a través dela uretra previamente dilatada. La gasa exteriorizadapor uretra pudo retirarse al tercer dia, sin que reaparecierala hematuria, aunque tuvo un posterior deterioroneurológico, falleciendo finalmente a los catorcedías de la última intervención.CONCLUSIÓN: El taponamiento vesical transuretral enuna mujer con hematuria intensa es una opción hemostáticaque recomendamos probar antes de elegir otrasmás dramáticas o invasivas

OBJECTIVES: Primary localized amyloidosis ;;of the urinary bladder generally has a benign course. ;;On the contrary, secondary amyloidosis, a consequence ;;of systemic amyloidosis, may have massive bleeding ;;and produce complications such as bladder rupture or ;;life-threatening hemodynamic problems requiring desperate ;;hemostatic procedures such as hypogastric artery ;;embolization or ligature, or cystectomy. We report one ;;case in which hemostasis was achieved by a Mickulicz ;;transurethral bladder tamponage. ;;METHODS: 58 year old female with very aggressive ;;rheumatoid arthritis and secondary renal amyloidosis ;;under chronic hemodialysis presenting with severe ;;hematuria after hip replacement. An inflamed bladder ;;was found, the biopsy of which showed edema in all ;;layers with blood vessel walls enlarged by amiloyd ;;deposits. After several unsuccessful transurethral hemostatic ;;procedures, intravesical formalin irrigation was carried ;;out together with a Mikulicz type gauze packaging after ;;urethral dilation. The gauze was withdrawn three days ;;later without bleeding recurrence; however she presented ;;subsequent neurological impairment and finally died 14 ;;days after the last urological procedure. ;;CONCLUSIONS: Transurethral packaging of the urinary ;;bladder in a woman with massive hematuria is a ;;hemostatic option that we recommend to be used before ;;other more dramatic or invasive options are chosen