Tratamiento quirúrgico ambulatorio de la incontinencia urinaria de esfuerzo femenina bajo anestesia local-sedación con cabestrillo transobturatriz de incisión única (Contasure-Needleless) / Outpatient Surgical Treatment of Female Stress Urinary Incontinence Under Local Anesthesia-sedation With Contrasure Needleless Incision

Objetivo: Evaluar los resultados obtenidos en el tratamiento quirúrgico ambulatorio de la incontinencia urinaria de esfuerzo femenina (IUE) con el empleo de un TOT de una sola incisión Contasure-Needleless (Neomedic-Internacional). Pacientes y método: Entre enero de 2007 y diciembre de 2011 hemos intervenido con anestesia local-sedación y en régimen estrictamente ambulatorio a 96 pacientes afectas de IUE mediante la colocación de cabestrillo suburetral sin tensión Needlelees. Se evalúan los criterios de inclusión y alta, así como los resultados obtenidos y el grado de satisfacción mediante la elaboración de un cuestionario. En todas las pacientes se realizó test de esfuerzo, estudio urodinámico y cuestionario de calidad de vida (ICIQ-SF) antes del procedimiento y al menos 3 meses después de la intervención. Resultados: La tolerancia al procedimiento fue buena. El tiempo quirúrgico fue inferior a 10 min y el de permanencia en el hospital hasta el alta menor de 2 h. Los resultados obtenidos son superponibles a los alcanzados con anestesia epidural e ingreso, siendo el grado de satisfacción con el tratamiento recibido superior al 90%. Conclusiones: La práctica totalidad de pacientes afectas son candidatas a incluirse en un programa de cirugía ambulatoria, mejorando ostensiblemente la relación coste-eficacia, no disminuyendo por ello la calidad asistencial ni el grado de satisfacción. Asimismo, el sistema Contasure-Needleless cumple los criterios de cirugía de mínima invasión, proporcionando una mayor estabilidad del cabestrillo que las «minibandas» de tercera generación, en virtud de una mayor longitud de la malla así como un menor dolor postoperatorio respecto al TOT convencional, por no precisar incisiones cutáneas

Objective: To evaluate the results obtained from out-patient surgical treatment of female stress urinary incontinence (SUI) with the use of trans-obturator tape (TOT) of a single Contrasure-Needleless incision (Neomedic-International). Patients and method: We performed an intervention with local anesthesia-sedation in outpatient regime between January 2007 and December 2011 on 96 patients affected by SUI using the placement of Needleless tension-free suburethral sling. Inclusion and discharge criteria and the results obtained as well as satisfaction grade were evaluated by a questionnaire. All the patients underwent a stress test, urodynamic study and quality of life questionnaire (ICIQ-SF) prior to and at least 3 months after the intervention. Results: Tolerance to the procedure was good. Surgical time was less than 10 min and stay in the hospital up to discharge less than 2 h. The results obtained are superimposable to those reached with epidural anesthesia and hospitalization, the grade of satisfactions with the treatment received being superior to 90%. Conclusions: Almost all of the patients affected are candidates for inclusion in an outpatient surgery program. This noticeably improves the cost-efficacy ratio, without decreasing the health care or grade of satisfaction. Furthermore, the Contasure-Needleless system fulfills the criteria for minimally invasive surgery, providing better stability of the sling than the third generation ‘minibands’ due to the greater length of the mesh and less post-operative pain regarding the conventional TOT as no cutaneous incisions are required

Outpatient surgical treatment of female stress urinary incontinence under local anesthesia-sedation with contrasure needleless incision.

OBJECTIVE: To evaluate the results obtained from out-patient surgical treatment of female stress urinary incontinence (SUI) with the use of trans-obturator tape (TOT) of a single Contrasure-Needleless incision (Neomedic-International). PATIENTS AND METHOD: We performed an intervention with local anesthesia-sedation in outpatient regime between January 2007 to December 2011 on 96 patients affected by SUI using the placement of Needleless tension-free suburethral sling. Inclusion and discharge criteria and the results obtained as well as satisfaction grade were evaluated by a questionnaire. All the patients underwent a stress test, urodynamic study and quality of life questionnaire (ICIQ-SF) prior to and at least 3 months after the intervention. RESULTS: Tolerance to the procedure was good. Surgical time was less than 10 minutes and stay in the hospital up to discharge less than 2hours. The results obtained are superimposable to those reached with epidural anesthesia and hospitalization, the grade of satisfactions with the treatment received being superior to 90%. CONCLUSIONS: Almost all of the patients affected are candidates for inclusion in an outpatient surgery program. This noticeably improves the cost-efficacy ratio, without decreasing the health care or grade of satisfaction. Furthermore, the Contasure-Needleless system fulfills the criteria for minimally invasive surgery, providing better stability of the sling than the third generation "minibands" due to the greater length of the mesh and less post-operative pain regarding the conventional TOT as no cutaneous incisions are required.

Visual impairment and quality of life: gender differences in the elderly in Cuenca, Spain.

PURPOSE: To estimate the prevalence of visual impairment (VI) in a population sample of older adults of the province of Cuenca, Spain and to evaluate the impact of VI on health-related quality of life (HRQOL) in this population group. METHODS: Cross-sectional observational study of the cohort of all persons over the age of 64 years from an urban area and rural nucleus of the province of Cuenca, Spain. Sociodemographic data were obtained and the VF-14 and SF-12 questionnaires were administered in an interview. One ophthalmologist evaluated the visual acuity (VA) and the presence of lens opacities, glaucoma, diabetic retinopathy, and age-related maculopathy. Prevalence of VI and blindness was defined according to the WHO criteria (0.5 log MAR or= 1.2 log MAR) and the European criteria (0.3 log MAR or= 1 log MAR) in the better eye. RESULTS: The study enrolled 1155 people out of a total of 1435 who were invited to participate (response rate 80.5%). The prevalence of VI and blindness according to the WHO criteria was 6.3 and 2%, respectively. Using the European criteria, the prevalence of VI was 21.1 and 2.4% the prevalence of blindness. The prevalence of VI was greater in older subjects (p < 0.0001); no significant gender-related differences were observed. The mean VF-14 score and means of the Physical Composite Score (PCS) and Mental Composite Score (MCS) of the SF-12 were lower in women than in men for all categories of visual acuity. The mean VF-14 score diminished as the degree of VI increased in all the pathologies studied, except glaucoma. The mean PCS score differed significantly by categories of VI, cataract, and diabetic retinopathy. The mean MCS score only differed with the degree of impairment of diabetic retinopathy. CONCLUSIONS: The prevalence of VI was among the highest reported until now in adults over 64 years old and increased with age. The deterioration in quality of life related to visual function increased with increased degree of VI for all the pathologies studied (cataract, diabetic retinopathy, age-related maculopathy) except glaucoma. The HRQOL was consistently worse in women than in men for all categories of deterioration of visual acuity.

Perfil cognitivo de la depresión mayor y la distimia: los errores en tareas acústico-vocales / Cognitive profile of major depresión and dysthimia: errors in vocal-acoustic performance

Dentro de los desórdenes afectivos, la distimia se considera modernamente una patología con entidad propia, aunque parte de la sintomatología típica de este trastorno coincide con varias de las manifestaciones características de la depresión mayor, razón por la cual el diagnóstico diferencial entre ambas patologías se hace complicado. El presente artículo se ha centrado en el análisis del rendimiento cognitivo mediante tareas acústico-vocales. En él participaron un total de sesenta voluntarios repartidos en tres grupos; personas sanas, pacientes con depresión mayor y pacientes con distimia. Se aplicó a todos ellos un protocolo acústico-vocal compuesto por tres tipos de tareas diferenciadas entre sí por su nivel de procesamiento cognitivo. Los resultados nos indican unas diferencias significativas en las distribuciones de errores que comenten los grupos de pacientes lo que sugiere un procesamiento cognitivo en la distimia cualitativamente diferenciado del de la depresión mayor

Among affective disorders, dysthymia is considered as a separated pathology, although one pan of its characteristic symptomatology coincides with some typical manifestations of mayor depression, complicating differential diagnosis between both entities. The study is focused on the cognitive performance analysis by using vocal-acoustic tasks. Sixty volunteers were divided in three groups: healthy subjects, major depression patients and persons with dysthymia. A vocal-acoustic protocol composed of three different cognitive processed level tasks was administered to all participants. Results showed significant different errors distributions between groups of patients suggesting that the cognitive processing in dysthymia and in mayor depression is qualitative different

[The validity and reliability of a questionnaire for assessing the functional capacity of older persons]. / Validez y fiabilidad de un cuestionario para valorar la capacidad funcional de las personas mayores.

OBJECTIVES: Our aim was to evaluate the validity and reliability of a questionnaire to measure the functional capacity in older people. DESIGN: Observational cross-sectional study. SETTING: Community level. Three basic health areas. PARTICIPANTS: 519 individuals over 64 selected by systematic random sampling taking as sampling units a list of household living at least an individual over 64 years. MEASUREMENTS AND MAIN RESULTS: A new questionnaire was developed starting from the OARS-MFAQ, the CVA. This new questionnaire is shorter but it maintains the same structure. Ten interviews were recorded in a videotape and subsequently analyzed and marked by four different observers to evaluate the inter-observer agreement. To assess the criterion validity the rates of 40 individuals in the CVA were compared with the rates assigned to the same individuals by experts in each area of the questionnaire (physical health, mental health, daily activities, economic resources, and social support). The criterion validity of the version to proxies of CVA (CVA-I) was studied comparing the answers in the CVA of 31 individuals and the answers given in the CVA-I by proxies of the same 31 individuals. The internal consistency in both versions of the questionnaire was studied in 519 individuals, agreement showed values of kappa coefficient between 0.43 and 0.69. Correlation coefficients Interobserver between expert's rates showed values between 0.54 and 0.74. Correlation coefficients between CVA and CVA-I showed values between 0.60 and 0.74 except in the social support dimension (0.16). The Cronbach alpha coefficient were 0.73 for CVA and 0.62 for CVA-I. CONCLUSIONS: The CVA questionnaire showed an acceptable validity and reliability except in the social support dimension of the CVA-I.

Familial aggregation of cardiovascular disease risk factors: the Cuenca Study.

OBJECTIVE: The familial aggregation of lipid levels, blood pressure, and body mass index (BMI) was studied in schoolchildren in Cuenca, Spain. METHODS: A cross-sectional observation study was made of 307 schoolchildren of both sexes, age range 9-12 years, from three schools in Cuenca, Spain, and of 346 parents. Social and demographic variables, weight, height, body mass index, systolic blood pressure, diastolic blood pressure, and fasting plasma concentrations of total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides were evaluated. RESULTS: The Spearman coefficients of correlation for total cholesterol, LDL-cholesterol, and BMI for parents and daughters were 0.34-0.42 (P < 0.01). These coefficients of correlation for parents and sons were lower (P > 0.05). The coefficient of correlation for blood pressure in parents and sons was low (P < 0.05). None of the variables showed any coefficient of correlation between spouses. The sexual differences in the correlations between the levels of the different variables were confirmed by multiple regression analysis. Total cholesterol and LDL-cholesterol levels and BMI accounted for larger percentages of variability in these parameters in daughters than in sons. The paternofilial aggregation of HDL-cholesterol and triglyceride levels was weak. The only variable that accounted for a significant variability in blood pressure (systolic and diastolic) was weight in children of both sexes. CONCLUSIONS: The familial aggregation of lipid levels and body mass index showed sex differences. The paternofilial aggregation of blood pressure was weak. There was no relation between spouses.

[Renal angiomyolipoma. Ultrasonography and computerized tomography findings]. / Angiomiolipomas renales. Reflexión sobre los hallazgos por ultrasonido y tomografía computerizada.

OBJECTIVE: To analyze the US and CT findings and their value in the diagnosis and follow-up of renal angiomyolipoma. METHODS/RESULTS: The clinical features, US and CT findings in 17 cases of renal angiomyolipoma were reviewed. Patient mean age was 49.1 years, 15 were asymptomatic and two presented with spontaneous bleeding. Two patients with Bourneville's disease presented bilateral lesions. The presumptive diagnosis was based on the US findings in 15 patients and on the CT findings in 16 patients. The remaining patient was evaluated by MRI. Three patients underwent partial nephrectomy and three other patients required total nephrectomy. CONCLUSIONS: Ultrasound is useful in the diagnosis of renal angiomyolipoma and it is probably the method of choice for follow-up. Two thirds were echogenic, although an echogenic lesion is not necessarily fat or viceversa. It is therefore necessary to perform a CT evaluation to make the diagnosis, especially if the tumor produces symptoms. In this series, detection of fat on CT evaluation was diagnostic of renal angiomyolipoma, although fatty tissue can also be found in other tumors or inflammatory lesions. Occasionally, the densitometric findings may not be conclusive due to the artefact of partial volume. The use of 5 mm slices without contrast and volumetric acquisitions for reconstruction can enhance the spatial resolution. It must also be taken into account that the fat content of a lesion can be scanty and may be undetected or not distinguished from other tumors.

[Familial aggregation of arterial pressure figures and weight indices: study in Cuenca]. / Agregación familiar de cifras de presión arterial e índices ponderales: estudio de Cuenca.

BACKGROUND: The aim of this study was to assess the familial aggregation of blood pressure and body mass index levels in schoolchildren of Cuenca city, Spain. SUBJECTS AND METHODS: A cross sectional study was made including 307 both sexes schoolchildren 9-12 years old recruited in three schools of Cuenca city, and 346 of their parents. There were determined sociodemographics variables, weight, height, body mass index, SBP, DBP and fasting plasma total cholesterol, cLDL, cHDL and triglyceride concentrations. RESULTS: Parents-children correlation coefficients in blood pressure levels ranged between -0.1 and 0.2. Parents-daughters correlations were stronger than parents-sons in ponderal indexes. The relationship of ponderal indexes and blood pressure between spouses was weak, with correlation coefficients between 0.08 y 0.1. By stepwise multiple regression analysis it was found that the only variable that explained a significant percentage of blood pressure variability (both systolic and diastolic) was the weight of the schoolchildren in both sexes. Parents body mass index explained more than 32% of body mass index daughter's variability. In sons any variable explained a significant percentage of variability. CONCLUSIONS: The parents-children aggregation of blood pressure is weak. Parents-children aggregation of ponderal indexes is stronger, though there are considerable sex-differences. Spouses relationship, though positive, is weak in all variables.

[Effect of LHRH agonists on testicular microcirculation with Doppler laser flowmetry]. / Acción de los agonistas LHRH sobre la microcirculación testicular medida mediante flujometria laser doppler.

The purpose of this paper is to present the changes that take place in testicular microcirculation measured by DLF during systemic administration of LHRH agonists. The essay includes a comparison with the variations registered in the volume of testicular interstitial fluid, the anatomopathological changes and the associated leucocyte demyeloperoxidase levels. We also examine the relationship between testicular microcirculation changes and plasma testosterone levels. To do this, 50 male Wistar rats were randomly divided into 5 groups, using 10 as control group and the remaining 40 distributed in 4 groups. Measurements were done at 2, 4, 8 and 24 hours after administration of Tryptorelin 0.4 mg i.v. We found that acute administration of an LHRH agonist causes a series of significant changes on testicular microcirculation. Testicular rhythmic microcirculatory flow, i.e., vasomotion, disappears. In turn, accumulation of PMN leucocytes associated to increased venular permeability takes places. Such pre- and postcapillary vascular changes lead to increased vascular permeability which results in increased volume of testicular interstitial fluid. This increased capillary permeability is responsible for the extensive interstitial oedema that would explain the serious histological changes seen on the seminiferous tubule with these drugs.

[Anatomopathologic changes in the testis following prolonged treatment with LHRH agonists. Experimental study in rats]. / Cambios anatomopatológicos en el testículo tras un tratamiento prolongado con agonistas LHRH. Estudio experimental en ratas.

Presentation of a study conducted on 20 male Wistar rats treated for 3 months with Leuprolide (LHRH agonist). Analysis of pathophysiological testicular changes resulting from the treatment and extent of recovery at 3 months of therapy discontinuation, relating those changes to testosterone plasma levels in peripheral blood. Serum testosterone fell to 1.17 +/- 0.30 ng/ml in the treated group, shifting to figures overlapping with normal values within 3 months of discontinuing treatment. Such decreased testosterone levels translate into significant testicular histological damage. Three months after interruption of treatment there is nearly complete recovery of such damage, with just around 10% tubules without spermatozoa, with unchanged germinal line. We conclude that the marked suppression in testosterone levels caused by LHRH agonists translates into a significant degeneration of the seminiferous tubule, which appears to be reversible 3 months after treatment discontinuation.

[Role of testosterone in the testicular microcirculatory changes produced in the rat by the administration of high doses of human chorionic gonadotrophin]. / Papel de la testosterona en las variaciones microcirculatorias testiculares producidas en la rata por la administración de altas dosis de gonadotrofina corionica humana.

A study was performed in 20 male Wistar rats weighing 250-300 gm; 10 comprised the control group and the other 10 were treated with 5 mg/day of cyproterone acetate which was given with the meal for 2 months. The rat testicular microcirculation was studied by laser Doppler flowmetry. Similarly, the testicular interstitial fluid volume and plasma testosterone in peripheral blood were determined. Within each of the two groups, 5 were studied without any pharmacologic stimulation and 5 at 4 hours following the administration of 100 IU subcutaneous HCG. The rats treated with cyproterone acetate had very low levels of serum testosterone (1.254 +/- 0.667) versus the control group (3.686 +/- 0.705), the difference being statistically significant (p < 0.05). Following administration of HCG, the microcirculation changes and the interstitial fluid were the same as those of the control group despite the blockade of the androgenic receptors by cyproterone acetate. The increase in testosterone levels therefore does not appear to mediate the testicular microcirculation changes produced by HCG.

[Testicular microcirculation in rats measured with laser-Doppler flowmetry]. / Microcirculación testicular en la rata medida mediante flujometría laser doppler.

Study carried out in 50 male Wistar rats distributed into 5 groups: baseline and at 2, 4, 8 and 24 hours after subcutaneous injection of Human Chorionic Gonadotropin, 100 IU. It was observed that testicular microcirculatory flow shows a rhythmical fluctuating pattern (5-10 fluctuations per minute), which becomes continuous at 4 hours but recovers at 24 hours. At the same time, there is an increased volume of testicular interstitial fluid that peaks at 8 hours, and returns to baseline levels at 24 hours. Serum testosterone values increase with HCG injection, reaching a peak at 4 hours (25.9 mg/ml), to return to nearly baseline levels at 24 hours (5.04 mg/ml). Disappearance of the rhythmical microcirculatory pattern, and the increase of interstitial fluid volume do not appear to be mediated by testosterone, since the raise in hormone levels, occurred after HCG administration, preceded the observed microcirculatory changes.

[Surgical treatment of urinary stress incontinence in women]. / Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en la mujer.

Long-term results obtained in 54 surgical procedures to correct effort urinary incontinence performed in 49 patients with this pathology are reviewed. One group was treated with suprapubic urethrovesical suspension with the Marshall-Marchetti-Krantz technique; the other group with endoscopic suspension of the neck of the bladder, with the Stamey technique and the third group with sling techniques. The authors conclude that any of the surgical techniques achieving a correct reposition of urethrovesical anatomy, rising the posterior urethra to its primitive anatomical bed, obtain a similar success rate.

[Percutaneous nephrostomy as a technic for emergency drainage: review of cases]. / La nefrostomía percutánea como técnica de derivación de urgencia: revisión de casos.

Percutaneous nephrostomy (PCN) is currently one of the procedures of choice for emergency drainage of the upper urinary tract. Moreover, it permits morphologic and functional diagnostic possibilities as well as a wide variety of new and frequently definitive therapeutic procedures. We report on 58 PCN procedures performed in 55 patients from May 1983 to February 1989. PCN was indicated for complicated or uncomplicated uni- or bilateral supravesical obstruction, with infection and/or azotemia. All patients submitted to PCN for complicated obstruction with infection and/or azotemia showed a marked clinical and analytical improvement. Apart from resolving this emergency, it reduced the morbidity and mortality rate of subsequent surgical treatment of the underlying cause of obstruction because patient status was markedly improved. The major complications, retroperitoneal hematoma and sepsis, were rare. We frequently observed that the catheter had come out or become obstructed in our series. PCN affords the following advantages: it can be performed with local anesthesia; it is a simple technique; there are no absolute contraindications; its morbidity and mortality rates are low; and, it can be easily converted into a permanent procedure. In our view, all the foregoing advantages, as well as its therapeutic and morphologic and functional diagnostic possibilities, make PCN one of the procedures of choice in emergency treatment of upper urinary tract obstruction.

[Calcification and contamination as complications in the use of double-J catheters: incidence and correlation]. / Calcificación y contaminación como complicaciones en el uso de catéteres ureterales doble-J: incidencia y correlación.

We present a series of cases of complex renal lithiasis, in which we carried out temporary internal urinary bypassing, prior to extracorporeal lithotripsy, by means of the retrograde insertion of a double-J urethral catheter, studying the time of stay, the presence or not of contamination in the catheter and its relationship with the calcifications found in them. We also carried out a metabolic-functional study of each patient, determining the urinary pH and the serum and urinary calcium, phosphorous and uric acid concentrations, and observing their possible influence on the above-mentioned complications. Of the 25 catheters studied, we observed calcification in 11 cases (44%). In these we observed urealytic germs (Proteus and Pseudomonas), without finding modifications of urinary pH. We observed no relationship between the calcium deposits and serum and urinary calcium, phosphorous and uric acid concentration.

[Retroperitoneal schwannoma: report of a case]. / Schwannoma retroperitoneal: aportación de un caso.

We report on a patient with a benign retroperitoneal schwannoma whose course had been followed clinically and pathologically for 11 years. The clinical features, diagnosis, prognosis, and treatment of this uncommon tumor type are discussed.

[Kidney pelvis calcification around a double-J ureteral catheter which was impossible to extract. Apropos of a case]. / Calcificación piélica en catéter ureteral doble-J que imposibilita su extracción. A propósito de un caso.

We present a case of pyelorenal calcification on double-J ureteral catheter, which made endoscopic extraction impossible. We review the literature and describe the incidence, methods of diagnosis and treatment of this complication, as well as the means used to avoid it.