[Local analgesia during flexible cystoscopy in male patients: A non-inferiority study comparing Xylocaine® gel to Instillagel® Lido]. / Anesthésie locale pour fibroscopie chez l'homme : étude de non-infériorité comparant le Xylocaine® gel à l'Instillagel® Lido.

INTRODUCTION: Local anesthesia using urethral gel has been proven to reduce discomfort of male patients during flexible cystoscopy. This study was a non-inferiority study between two lidocain-containing urethral gel (Instillagel® Lido and Xylocaine® gel). METHODS: A prospective single center study was conducted between June 2014 and November 2014. Male patients seen in the office and in whom a flexible cystoscopy was planned were included in the present study and received urethral instillation of either Xylocaine® gel or Instillagel® Lido at least 5minutes before flexible cystoscopy. No other anesthetic agent was used. Primary endpoint was pain during the procedure, assessed through visual analog scale (VAS) from 0 to 10. RESULTS: Four hundred and sixty-one men were included: 233 in the Instillagel® Lido group and 228 in the Xylocaine® gel group. Indications of flexible cystoscopy non-muscle invasive bladder cancer follow-up in 44 % of cases, hematuria work-up in 21 % of cases and lower urinary tract symptoms work-up in 35 %. Patients' age was comparable betwwen both groups: 64.5 years (±1.1) in the Instillagel® Lido group and 66.2 years (±1.1) in the Xylocaine® gel group (P=0.29). The mean VAS was 0.8 (±0.1) in the Instillagel® Lido group and 0.6 (±0.1) in the Xylocaine® gel group (P=0.10). The non-inferiority criterion was reached (P<0.001) as the average difference in VAS between the two groups was 0.2 with a confidence interval not comprising 1 (CI 97.5 %: -0.47; 0.07). CONCLUSION: In this prospective study, Instillagel® Lido was not inferior to Xylocaine® gel for local analgesia during flexible cystoscopy in male patients. LEVEL OF EVIDENCE: 4.

Direct communication between right pulmonary artery and left atrium.

A case of direct communication between right pulmonary artery and left atrium is reported. The diagnosis was made before surgical correction. A surgical ligation of the fistula resolved the cyanosis of the patient. Selective angiocardiogram of the right pulmonary artery 4 months after surgery revealed no residual shunt. This very rare malformation should be considered in the clinical setting of unexplained cyanosis. This is the number 50 case reported in the literature.

[Percutaneous treatment of multiple heart defects]. / Tratamiento por vía percutánea de múltiples defectos cardiacos.

We describe our experience in 6 cases with multiple congenital heart defects treated by percutaneous intervention. Their age ranged from 2.3 to 10 years (mean 6.1), with follow-up from 1 to 84 months (mean 28.8). Two cases had coarctation of the aorta (AC) and persistent ductus arteriosus (PDA). Two patients had pulmonary valve stenosis (PVS) and PDA, one case with aortic stenosis (AE) and PDA and one case with AC, mitral stenosis and subaortic stenosis (Shone's Syndrome). Ductus arteriosus was occluded in all patients with Gianturco coils or Rashkind occluder. The valvular gradient post balloon decreased in cases with AC from 46 to 9 mmHg, with PVS from 110 to 10 mmHg and with AE from 40 to 14 mmHg. In a 8 year old boy with Shone's syndrome, we performed angioplasty of aortic coarctation, mitral valvuloplasty with Inoue catheter. He was referred to surgery for subaortic repair stenosis. All are asymptomatic at follow-up. In conclusion; percutaneous intervention is possible in patients with multiple congenital heart defects.

[Transcatheter closure of ductus arteriosus with coils. Immediate results. Initial experience in Mexico]. / Cierre transcateterismo del conducto arterioso mediante espirales (coils). Resultados inmediatos. Experiencia inicial en México.

From March to May 1996 we performed transcatheter closure of patent ductus arteriosus with spring coils in 4 patients. Age ranged from 5 month to 11 years (mean 4.3 years). One of them had two previous Rashkind occluders with persistant shunt and other case had pulmonary valve stenosis, in this case we performed pulmonary valvuloplasty and after that closure of ductus arteriosus. Mean pulmonary arterial pressure was 10 to 38 mmHg (mean 18), QP/QS was 1.2 to 5.0 (mean 3.2). Immediate total occlusion occurred in two cases and the other had trivial shunt by doppler echocardiography. No complications were detected. In conclusion we believe that this device is another no surgical alternative to treat persistant ductus arteriosus. It is effective, it has a low cost, and all the patients are candidates. The procedure carries minimum risk and has no mortality.