Early ureteroscopic treatment in patients with urosepsis associated with ureteral calculi is a safe approach. A pilot study.

INTRODUCTION: Emergency drainage of the urinary tract is the first necessary approach in patients with urosepsis secondary to obstructive ureteral calculi. The appropriate waiting time before definitive treatment has not been determined. We hypothesized that early ureteroscopic treatment after the patient has been stabilized is as safe as deferred treatment. MATERIAL AND METHODS: A pilot study was developed between November 2013 and September 2017. Patients with urosepsis associated with ureteral calculi were included. All the patients were initially decompressed with a ureteral stent. Patients were randomized to early ureteroscopic treatment (EUT), who received definitive treatment during the initial hospitalization, or deferred ureteroscopic treatment (DUT), that received definitive treatment in a second hospitalization. The stone location and size, sex distribution, age, APACHE II score, length of hospital stay, days with ureteral catheter and complications were registered. Statistical analysis was performed using Stata 12.0. RESULTS: A total of 13 patients were included in the EUT group and 13 in the DUT group. No differences in sex distribution, stone location, APACHE II score, age, stone size and time between admission and urinary drainage were found. Total length of hospital stay and complications were also similar between both groups. A statistically significant difference was found in terms of duration of antibiotic treatment (p = 0.04) and total days with double J catheter (p = 0.0009). CONCLUSIONS: EUT for ureteral stone is as safe as DUT in patients admitted with urosepsis secondary to ureterolithiasis. EUT is associated with a shorter period of ureteral stent and it is not associated with an increase in complications.

Endoscopic Treatment of Fibroepithelial Polyp of the Ureter: Case Report.

Background: Fibroepithelial polyp of the ureter is a very rare benign tumor of the urinary tract that can present complications as urinary tract infection, hematuria, or urinary retention. Its incidence has increased in recent years. Its recognition and proper management are important to avoid invasive surgeries. Case Presentation: We present the case of a 24-year-old Latin pregnant woman with gross hematuria, right flank pain, and a bladder tumor as seen on a pelvic ultrasonography. Cystoscopy and MRI showed a right ureteral tumor that protruded through the ureteral meatus. Endoscopic resection using a holmium:YAG laser was performed during the second trimester of pregnancy. A ureteral tumor of 6.5 cm was completely resected. Histopathology showed morphological findings compatible with a fibroepithelial ureteral polyp. The postoperative evolution was satisfactory with no complications or recurrences to date. Conclusion: Fibroepithelial polyp of the ureter is a benign tumor that can be present in any of the ureter's segments. It usually affects people between 20 and 40 years. Endoscopic resection with holmium laser has become the preferred surgical treatment during the last time. It is associated with the advantages of a minimal invasive technique and a short period of convalescence.

Tau cleavage at D421 by caspase-3 is induced in neurons and astrocytes infected with herpes simplex virus type 1.

Herpes Simplex Virus Type 1 (HSV-1) is ubiquitous, neurotropic, and the most common pathogenic causes of sporadic acute encephalitis in humans. Herpes simplex encephalitis is associated with a high mortality rate and significant neurological, neuropsychological, and neurobehavioral sequelae, which afflict patients for life. HSV-1 infects limbic system structures in the central nervous system and has been suggested as an environmental risk factor for Alzheimer's disease. However, the possible mechanisms that link HSV-1 infection with the neurodegenerative process are still largely unknown. In a previous study we demonstrated that HSV-1 triggers hyperphosphorylation of tau epitopes serine202/threonine205 and serine396/serine404 in neuronal cultures, resembling what occurs in neurodegenerative diseases. Therefore, the aim of the present study was to evaluate at the cellular level if another event associated with neurodegeneration, such as caspase-3 induced cleavage of tau, could also be triggered by HSV-1 infection in primary neuronal and astrocyte cultures. As expected, induction of caspase-3 activation and cleavage of tau protein at its specific site (aspartic acid 421) was observed by Western blot and immunofluorescence analyses in mice neuronal primary cultures infected with HSV-1. In agreement with our previous study on tau hyperphosphorylation, tau cleavage was also observed during the first 4 hours of infection, before neuronal death takes place. This tau processing has been previously demonstrated to increase the kinetics of tau aggregation in vitro and has also been observed in neurodegenerative pathologies. In conclusion, our findings support the idea that HSV-1 could contribute to induce neurodegenerative processes in age-associated pathologies such as Alzheimer's disease.

Low-level laser-assisted liposuction: the Neira 4 L technique.

Low-level laser-assisted liposuction (LLLL), known as the Neira 4 L technique, is an excellent adjuvant tool for the surgeon practicing liposculpture. A low-level laser is used to create a transitory pore in the cell membrane of the adipocyte to move fat from inside the cell to the interstitial space outside without killing the cell. LLLL has been performed successfully in in-vitro and human adipose tissue cultures. It protects the patient from the surgical trauma of liposuction by protecting and preparing tissues for the surgical trauma; modulating the inflammatory response to prevent short and long-term side effects of surgery; and improving the quality and quantity of the healing process by accelerating recovery time, modulating secondary cicatrization, and preventing postoperative neuralgias.

Fat liquefaction: effect of low-level laser energy on adipose tissue.

Low-level laser energy has been increasingly used in the treatment of a broad range of conditions and has improved wound healing, reduced edema, and relieved pain of various etiologies. This study examined whether 635-nm low-level lasers had an effect on adipose tissue in vivo and the procedural implementation of lipoplasty/liposuction techniques. The experiment investigated the effect of 635-nm, 10-mW diode laser radiation with exclusive energy dispersing optics. Total energy values of 1.2 J/cm(2), 2.4 J/cm(2), and 3.6 J/cm(2) were applied on human adipose tissue taken from lipectomy samples of 12 healthy women. The tissue samples were irradiated for 0, 2, 4, and 6 minutes with and without tumescent solution and were studied using the protocols of transmission electron microscopy and scanning electron microscopy. Nonirradiated tissue samples were taken for reference. More than 180 images were recorded and professionally evaluated. All microscopic results showed that without laser exposure the normal adipose tissue appeared as a grape-shaped node. After 4 minutes of laser exposure, 80 percent of the fat was released from the adipose cells; at 6 minutes of laser exposure, 99 percent of the fat was released from the adipocyte. The released fat was collected in the interstitial space. Transmission electron microscopic images of the adipose tissue taken at x60,000 showed a transitory pore and complete deflation of the adipocytes. The low-level laser energy affected the adipose cell by causing a transitory pore in the cell membrane to open, which permitted the fat content to go from inside to outside the cell. The cells in the interstitial space and the capillaries remained intact. Low-level laser-assisted lipoplasty has a significant impact on the procedural implementation of lipoplasty techniques.