Systemic therapies for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: a SCORTEN-based systematic review and meta-analysis.

BACKGROUND: The SCORTEN score is a specific predictor of mortality for patients with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). There is little evidence in support of the common immunomodulating therapies for SJS/TEN. OBJECTIVES: To systematically assess the effectiveness of several therapies for SJS/TEN through the SCORTEN score. METHODS: Databases were searched for original studies on the use of SCORTEN. Six meta-analyses were carried out on patients with SJS/TEN who received supportive care only or in combination with immunomodulating drugs: corticosteroids, cyclosporine, etanercept, immunoglobulins or a combination of corticosteroids with immunoglobulins. A multivariate meta-regression and a network meta-analysis were also performed. RESULTS: Of 3893 studies identified, fifty-two involving 2466 patients with SJS/TEN were preselected. Data from thirty-eight of these studies (1827 patients) were finally pooled, and results [log(SMR)] from meta-analyses were as follows: -0.13 (95% CI, -0.42,0.16) for corticosteroids, -0.39 (95% CI, -0.87,0.09) for immunoglobulins, 0.13 (95% CI, -0.15,0.40) for supportive treatment, -0.88 (95% CI, -1.47, -0.29) for cyclosporine, -0.95 (95% CI, -1.82, -0.07) for etanercept and - 0.56 (95% CI, -0.94, -0.19) for immunoglobulins plus corticosteroids. The meta-regression analysis confirmed that cyclosporine and immunoglobulins plus corticosteroids were associated with less deaths than predicted by SCORTEN. In the network meta-analysis, no treatment achieved a significant reduction in the SMR. LIMITATIONS: Heterogeneity and quality of the included studies. CONCLUSIONS: Some treatments for SJS/TEN show a better performance, but there is not sufficient evidence to recommend its widespread use in all patients.

Accuracy of SCORTEN to predict the prognosis of Stevens-Johnson syndrome/toxic epidermal necrolysis: a systematic review and meta-analysis.

BACKGROUND: The SCORTEN score is a specific predictor of the probability of death for patients diagnosed with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). OBJECTIVES: To evaluate the overall accuracy of SCORTEN and the influence of several moderators such as age, sex, geographical region and age of the study. METHODS: A systematic search was performed on MEDLINE, The Cochrane Library, EMBASE, SCOPUS and Web of Knowledge, with no restriction on language (last update 5 February 2019 for all databases). Original studies on the use of SCORTEN were eligible. The standardized mortality ratio (SMR), defined as the quotient between the number of deaths observed and the number expected following SCORTEN, was taken as the measurement of analysis. RESULTS: Sixty-four papers were part of the main meta-analysis carried out in the study. A pooled log(SMR) of -0.0889 (95% CI: -0.2023 to 0.0245) was obtained, suggesting a reasonable behaviour of SCORTEN as a predictor of mortality. The possible influence of several factors in the accuracy of SCORTEN was studied by means of meta-regression models. Multivariate meta-regression allowed finding that the mean age of the patients and the ending year of the study are the only factors that significantly influence SCORTEN predictions. The mean age of the group of patients was associated with a significant increase in the observed/expected ratio, whereas a progressive reduction in the observed/expected ratio can be appreciated over the years. Finally, an underestimation of mortality was found for SCORTEN values of 3 or less and the opposite for those above 3 (SCORTEN range: 0-7). CONCLUSIONS: The rarity of the disease and the heterogeneity of the studies included are major limitations. Despite the overall remarkable accuracy displayed by SCORTEN, the influence of several factors, as comorbidities (e.g. renal impairment), involved body surface area and patient's age, seem of enough relevance to consider a redefinition of the scale.

Estudio comparativo entre láser tulio (Tm: YAG) 150W y láser verde (LBO:ND-YAG) 120W para el tratamiento de la hiperplasia benigna de próstata: eficacia y seguridad a corto plazo / Comparative study between thulium laser (Tm: YAG) 150W and greenlight laser (LBO:ND-YAG) 120W for the treatment of benign prostatic hyperpplasia: short-term efficacy and security

Objetivo: Comparar los resultados de eficacia y seguridad del láser tulio 150W frente a láser verde 120W en el tratamiento de la hiperplasia benigna de próstata a corto plazo (12 meses de la cirugía). Material y métodos: Estudio retrospectivo observacional, donde se incluyen varones intervenidos con la técnica de fotovaporización prostática durante un periodo de 4 años en nuestro centro. Se comprobó la homogeneidad de la muestra, y se compararon las complicaciones postoperatorias (retención aguda de orina, reingreso, necesidad de transfusión), los fracasos al año de la cirugía (reintervenciones, flujo máximo < 15ml/seg, ausencia de mejoría en el I-PSS) y disminución de PSA al año de la cirugía. Análisis bivariante mediante Chi-cuadrado y «t» de Student. Resultados: Ciento dieciséis pacientes tratados con tulio y 118 con láser verde. Muestra homogénea para variables preoperatorias (p>0,05). No se objetivaron diferencias en las complicaciones: en retenciones agudas de orina, 4,3% con tulio y 6,8% con láser verde (p = 0,41); en reingresos 2,6% con tulio y 1,7% con láser verde (p = 0,68); en necesidad de transfusión 2,6% con tulio y 0% con láser verde (p = 0,12). Tampoco se observaron diferencias en el porcentaje de pacientes reintervenidos (1,7% en el grupo de tulio, 5,1% en el de láser verde, p = 0,28), ni en el de individuos con Qmáx menor de 15 ml/seg (6,9% con tulio, 6,77% con láser verde, p = 0,75), ni en el de ausencia de mejoría del I-PSS (5,2% con tulio, 3,4% con láser verde, p = 0,65). Tampoco hubo diferencia en los niveles de PSA en ng/ml al año de la cirugía: con tulio 2,78 ± 2,09 y con láser verde 1,83±1,48 (p = 0,75). Conclusiones: La fotovaporización prostática con láser tulio 150W es comparable a la realizada con láser verde de 120 W para el tratamiento de los síntomas obstructivos del tracto urinario inferior por HBP, siendo ambas técnicas eficaces y seguras a los 12 meses de la intervención. Futuros estudios prospectivos aleatorizados son necesarios para confirmar esta conclusión sobre ambas técnicas

Objective: To compare the results of efficacy and safety of Thulium laser 150 W against Greenlight laser 120 W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). Material and methods: This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow < 15ml/sec, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out. Results: 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (P > .05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (P = .41); in readmissions, 2.6% with thulium and 1.7% with green laser (P = .68); in need for transfusion, 2.6% with thulium and 0% with green laser (P = .12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, P = .28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, P = .75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, P = .65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78 ± 2.09 and with green laser 1.83 ± 1.48 (P = .75). Conclusions: Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques

Comparative study between thulium laser (Tm: YAG) 150W and greenlight laser (LBO:ND-YAG) 120W for the treatment of benign prostatic hyperpplasia: Short-term efficacy and security. / Estudio comparativo entre láser tulio (Tm: YAG) 150W y láser verde (LBO:ND-YAG) 120W para el tratamiento de la hiperplasia benigna de próstata: eficacia y seguridad a corto plazo.

OBJECTIVE: To compare the results of efficacy and safety of Thulium laser 150W against Greenlight laser 120W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). MATERIAL AND METHODS: This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow <15ml/sec, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out. RESULTS: 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (P>.05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (P=.41); in readmissions, 2.6% with thulium and 1.7% with green laser (P=.68); in need for transfusion, 2.6% with thulium and 0% with green laser (P=.12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, P=.28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, P=.75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, P=.65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78±2.09 and with green laser 1.83±1.48 (P=.75). CONCLUSIONS: Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques.

Hemorragia renal tras LEOC: del pequeño hematoma al estallido renal / Renal hemorrhage after eswl: From small hematoma to renal blowout

OBJETIVO: Presentar dos casos de hemorragia renal tras litotricia extracorpórea con ondas de choque (LEOC) y su manejo terapéutico. MÉTODO: Descripción de los casos clínicos, además del diagnóstico y el manejo terapéutico de este tipo de complicaciones. RESULTADOS: Presentamos dos casos de pacientes con hemorragia renal tras LEOC, las cuales fueron realizadas sin incidencias inmediatas. Uno de los casos, tras objetivar laceración importante del parénquima renal, precisó dos embolizaciones para su resolución a corto plazo, aunque la paciente finalmente falleció por las complicaciones derivadas de la hemorragia. El otro se resolvió con manejo conservador. CONCLUSIONES: Aunque la hemorragia renal es una complicación infrecuente tras LEOC, debe sospecharse cuando el paciente presente clínica compatible, pues aunque la mayoría de los casos se resuelven de forma conservadora, en ocasiones son necesarios tratamientos específicos de la hemorragia. La edad avanzada y la presencia de comorbilidades vasculares parecen relacionarse con un mayor riesgo de hemorragia tras LEOC

OBJECTIVE: To report two cases of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL) and their therapeutic management. METHODS: Description of the clinical cases, together with the diagnosis and therapeutic management of these complications. RESULTS: We present two cases of patients with renal hemorrhage after ESWL, which were performed without immediate complications. One of the cases, after detecting an important laceration of the renal parenchyma, needed two embolization sessions for its short-term resolution; however, the patient finally passed away due to the complications derived from hemorrhage. The other case was solved through conservative management. CONCLUSIONS: Even though hemorrhage is an infrequent complication after ESWL, it should be suspected when the patient presents compatible clinical symptoms, since even though most cases are resolved in a conservative manner, on some occasions specific treatments for the hemorrhage are necessary. Old age and the presence of vascular comorbidities seem to be related to a higher risk of hemorrhage after ESWL

In-vivo dosimetry for field sizes down to 6 × 6 mm2 in shaped beam radiosurgery with microMOSFET.

The aim of this study is to evaluate microMOSFET as in-vivo dosimeter in 6 MV shaped-beam radiosurgery for field sizes down to 6 × 6 mm2. A homemade build-up cap was developed and its use with microMOSFET was evaluated down to 6 × 6 mm2. The study with the homemade build-up cap was performed considering its influence on field size over-cover occurring at surface, achievement of the overall process of electronic equilibrium, dose deposition along beam axis and dose attenuation. An optimized calibration method has been validated using MOSFET in shaped-beam radiosurgery for field sizes from 98 × 98 down to 18 × 18 mm2. The method was detailed in a previous study and validated in irregular field shapes series measurements performed on a head phantom. The optimized calibration method was applied to microMOSFET equipped with homemade build-up cap down to 6 × 6 mm2. Using the same irregular field shapes, dose measurements were performed on head phantom. MicroMOSFET results were compared to previous MOSFET ones. Additional irregular field shapes down to 8.8 × 8.8 mm2 were studied with microMOSFET. Isocenter dose attenuation due to the homemade build-up cap over the microMOSFET was near 2% irrespective of field size. Our results suggested that microMOSFET equipped with homemade build-up cap is suitable for in-vivo dosimetry in shaped-beam radiosurgery for field sizes down to 6 × 6 mm2 and therefore that the required build-up cap dimensions to perform entrance in-vivo dosimetry in small-fields have to ensure only partial charge particle equilibrium.

An optimized calibration method for surface measurements with MOSFETs in shaped-beam radiosurgery.

Nowadays MOSFET dosimeters are widely used for dose verification in radiotherapy procedures. Although their sensitive area satisfies size requirements for small field dosimetry, their use in radiosurgery has rarely been reported. The aim of this study is to propose and optimize a calibration method to perform surface measurements in 6 MV shaped-beam radiosurgery for field sizes down to 18 × 18 mm(2). The effect of different parameters such as recovery time between 2 readings, batch uniformity and build-up cap attenuation was studied. Batch uniformity was found to be within 2% and isocenter dose attenuation due to the build-up cap over the MOSFET was near 2% irrespective of field size. Two sets of sensitivity coefficients (SC) were determined for TN-502RD MOSFET dosimeters using experimental and calculated calibration; the latter being developed using an inverse square law model. Validation measurements were performed on a realistic head phantom in irregular fields. MOSFET dose values obtained by applying either measured or calculated SC were compared. For calibration, optimal results were obtained for an inter-measurement time lapse of 5 min. We also found that fitting the SC values with the inverse square law reduced the number of measurements required for calibration. The study demonstrated that combining inverse square law and Sterling-Worthley formula resulted in an underestimation of up to 4% of the dose measured by MOSFETs for complex beam geometries. With the inverse square law, it is possible to reduce the number of measurements required for calibration for multiple field-SSD combinations. Our results suggested that MOSFETs are suitable sensors for dosimetry when used at the surface in shaped-beam radiosurgery down to 18 × 18 mm(2).

[Treatment of trigeminal neuralgia with radiosurgery]. / Traitement de la névralgie essentielle du trijumeau par radiochirurgie stéréotaxique.

Idiopathic trigeminal neuralgia is defined as brief paroxysms of pain limited to the facial distribution of the trigeminal nerve. Drug therapy is considered to be the first-line of treatment for trigeminal neuralgia. Unfortunately, medical treatment does not always provide satisfactory pain relief for 25% of the patients. Moreover, the relief provided by drug therapy generally decreases over time, and increased dosages of these medications are limited because of side effects. In this case, patients can be offered several surgical approaches, such as percutaneous techniques (thermocoagulation, microcompression, glycerol injection) or microvascular decompression in the cerebello-pontine angle (Gardner-Jannetta's technique). In this indication, stereotactic radiosurgery, driven by teams using Gamma Knife(®), has shown promising efficacy and tolerance to allow this treatment being truly part of trigeminal neuralgia treatment. Technological progresses now allow performing radiosurgery with ballistic and dosimetric processes optimized with stereotactic radiosurgery dedicated linear accelerators. This procedure supports frame implantation to guarantee targeting accuracy in accordance of elevated dose distribution. This article on trigeminal neuralgia treatment will review the different medical and surgical therapeutic options and specify the contemporary place of stereotactic radiosurgery in the light of its clinical results and tolerance aspects.

[Medical devices needed for stereotactic radiosurgery and intracranial stereotactic radiotherapy]. / Équipements requis pour la mise en œuvre de la radiochirurgie et de la radiothérapie en conditions stéréotaxiques intracrânienne.

Since the previous special issue of Cancer Radiothérapie dedicated to radiosurgery in 1998, many important technological and computer developments have improved external beam radiotherapy treatment device performances. Whereas the Gamma Knife(®) was the gold standard for intracranial radiosurgery, new linear accelerator developments have led to new possibilities for the clinicians. This article describes quickly the different devices available for cranial radiosurgery or fractionated stereotactic radiotherapy.

[Stereotactic and diagnostic imaging in radiosurgery]. / Imagerie stéréotaxique et diagnostique en radiochirurgie.

Constant progress in medical imaging and particularly magnetic resonance imaging has profound impact in planning for stereotactic radiosurgery and radiotherapy. The purpose of this paper is to discuss the integration of medical imaging modalities in the planning process. Principles of generic algorithms to calculate stereotactic coordinates are treated for tomographic imaging and digital substraction angiography, and their accuracies are analyzed in a review of the literature. The algorithmic foundations and performance of automatic intermodality co-registration methods are developed. Finally, the MRI sequences useful in planning and follow-up are discussed and the role of MR angiographic sequences compared to conventional X-ray angiography in the particular case of the arteriovenous malformation planning.

[Dosimetric stereotactic radiosurgical accident: Study of 33 patients treated for brain metastases]. / Traitement des métastases cérébrales par radiochirurgie stéréotaxique : étude de 33 cas liés à un accident de "surexposition".

The consequences of a dosimetric radiosurgery accident are not the same as a conventional radiotherapy accident. The objective of this study was to estimate the clinical and radiological outcome of patients treated by radiosurgery for metastasis during the period of the overexposure accident that occurred in the Toulouse Radiosurgery Unit. Between April 2006 and March 2007, 33 patients with 57 metastases were treated in the Toulouse Radiosurgery Unit (Novalis(®), BrainLab). An initial error in the estimation of the scatter factors led to an overexposure to radiation. The median age was 55 years [range, 35-85]. Twenty-one patients (64%) harbored a single metastasis. The primary tumor location was lung (16 cases), kidney (nine cases), breast (four cases), and others (four cases). The mean tumoral volume was 3.2cm(3) [0.04-14.07]. The mean prescribed dose at the isocenter was 20 Gy [range, 10-23], the mean delivered dose was 31.5 Gy [range, 13-52], and the mean overdose was 61.2% [range, 5.6-226.8]. In order to evaluate the consequences of the overdose, three parameters were analyzed: a risk index using dose and volume, the volume of parenchyma that received more than 12 Gy, and the mean dose in a sphere of 20cm(3) surrounding the target volume. Median actuarial survival was 14.1 months, the survival rate was 79.4 % at six months, 59.1% at 12 months, and 27.2% at 24 months. The rate of tumor control was 80.7%. No morbidity was observed. There was no correlation between death and the parameters studied. The survival rates and times observed in our study of the patients treated for brain metastases by radiosurgery and overexposed were among the good results of the international literature. Deaths were not related to the overdose and no side effect was noted. This dosimetric accident has not had worse consequences in this population.

[Neuromotor assessment of patients with spastic cerebral palsy treated with orthopedic surgery at the National Rehabilitation Institute]. / Evaluación neuromotora de pacientes con parálisis cerebral espástica tratados con cirugía ortopédica en el Instituto Nacional de Rehabilitación.

BACKGROUND: Cerebral palsy (CP) is a static neurologic condition resulting from a brain lesion occurring before the completion of brain development. The goal of management is not cure, but increasing patients' functionality and improving their capabilities and maintaining their locomotion, cognitive development, social interaction and independence. The best results are obtained with an early and intensive management that includes physical and occupational therapy, medical and surgical treatments, mechanical aids and the management of concomitant conditions. OBJECTIVE: To assess the neuromotor improvement in patients with spastic CP after surgical treatment at the National Rehabilitation Institute. PATIENTS AND METHODS: Patients with a diagnosis of spastic CP who presented at the Pediatric Rehabilitation outpatient service were referred to the Joint CP Clinic from January 2007 to January 2008, and underwent surgical treatment of the pelvic limbs. They were assessed 3 times and underwent neuromotor tests with gross motor function measure (GMFM), which was rated with the gross motor function classification system (GMFCS). RESULTS: Most of the patients had improvement in the muscle tone and contracture assessments as well as in the GMFM, and their self-mobility increased one level. CONCLUSIONS: Significant improvements were seen in the muscle tone and contractures after surgery; the GMFM and the self-mobility levels in the GMFCS also improved. Multiple level surgery together with a postoperative physical therapy program results in considerable improvements in the gross motor function measure of patients with spastic CP.

[On board imaging with cone beam CBCT kV VARIAN: Montauban's radiation therapy department experience]. / Système d'imagerie par tomographie conique de basse énergie (kV)de Varian : expérience de Montauban.

PURPOSE: To describe our practice day to day with a VARIAN linac "Clinac 2100" fully equipped with an On Board Imager (OBI) for patients with prostate cancer. MATERIALS AND METHODS: A volumetric and dosimetric study was performed in 2006 using ARTIVIEW software (AQUILAB) for nine patients and 76 Cone Beam CT kV (CBCT kV). We have contoured targets and organs at risk from CBCT kV slides acquisitions. Second, we achieved a dose-volume histogram (DVH) study for a patient treated in 2007 with IMRT technique in comparison with the 2006 study. RESULTS: 2006 analysis: The study showed a very important variability of organ measurements. Seminal vesicles were strongly influenced by adjacent organs; observed differences for prostate could be explained by contouring uncertainty on the apex. Inter-sessions motions could be observed for bladder, rectum and seminal vesicles (SV). Part of prostate volume not encompassed by PTV is about 2.5%; VS volume outside PTV is about 35%. Tumoral conformation index (TCI) is inferior to 97.5% in 22% of all cases. Anteroposterior displacements of the prostate barycentre is superior to 5mm. From this analysis, we recommended the strict respect of hygienodietetic rules, and we have adapted the system settings for better immobilization, which were applied for the 2007 study. For the 2007 analysis, since April 2007, most of patients are treated with IMRT for prostate cancer, at the second part of the radiation therapy to encompass only the prostate volume. Dose-volume histograms showed a great spreading out for 2006 patients, and not for the 2007 patient. CONCLUSIONS: IMRT and IGRT should permit a margin reduction for PTV. Strict respect of hygienodietetics rules is necessary to avoid rectal distension and local recurrence.

[Role of chronic prostatic infiltrate from specimens of prostate biopsy in total and free PSA determination]. / Influencia de la inflamación crónica prostática en muestras de biopsia sextante en los niveles séricos de PSA total y PSA libre.

PURPOSE: To analyze the influence in total serum PSA (PSA(t)) and free PSA (PSA(1)) of chronic inflammatory patterns from prostate biopsy specimens of non-symptomatic patients. PATIENTS AND METHODS: 518 non-symptomatic patients underwent ultrasonography and prostatic biopsy for PSA(t) > 4 ng/mL and/or DRE suspicious of malignancy. Those with a negative biopsy were divided into two subgroups: patients with benign prostatic lesions (LBP) and patients with chronic inflammatory signs (SIC). RESULTS: 456 patients (88.03%) were biopsied for elevated PSA(t) or/and DRE suspicious of malignancy in 62 patients (11.97%). Mean volume in patients with LBP was 54cc, while 51cc was the mean volume in patients with histological pattern of chronic inflammatory infiltrate. Mean PSA(t) in patients with LBP was 9.43 (IC 95% +/- 7.8) and 8.8 (IC 95% +/- 5.73) in SIC's group patients. CONCLUSIONS: The presence of SIC has no significant influence in the eventual value of PSA(1) y PSA(t) in a selected population. As a result of that finding data from serum PSA can be reliably evaluated even in the presence of SIC in biopsy specimens.

Evaluación de la satisfacción de los pacientes ingresados en una unidad de corta estancia de urgencias / Assessment of patient satisfaction among those admitted into a short-stay emergency unit

Objetivos: Evaluar la satisfacción de los pacientes ingresados en una unidad de corta estancia de urgencias (UCEU) mediante una encuesta autoadministrada. Métodos: Los parámetros incluidos en la encuesta fueron estancia en urgencias, personal sanitario, aspectos de hostelería e información escrita que se proporciona al ingreso. Las opciones de respuesta eran muy bien, bien, regular y mal. Además, se preguntaba a los pacientes si consideraban que se había solucionado su problema de salud actual y si volverían a ingresar en el mismo centro. Resultados: Se realizaron 954 ingresos a 854 pacientes (451 hombres y 403 mujeres) con una edad media de 71 ± 15 años y una estancia media de 3,0 ± 1,8 días. Los pacientes respondieron 283 encuestas (30% de los ingresos). La estancia en urgencias, el personal sanitario, la coordinación entre los distintos profesionales y el horario de visitas fueron evaluados como muy bien o bien por el 99% de los pacientes. En los aspectos de hostelería, peor valorados, destaca el apartado de valoración del nivel de ruido de la unidad (44% de los pacientes calificaron regular o mal). La información proporcionada al ingreso es considerada útil. Doscientos quince pacientes (76%) consideraron que se había solucionado su problema de salud y 246 (87%) volverían a ingresar en la UCEU. Conclusiones: El grado de satisfacción de los pacientes de la UCEU es muy elevado. La mayoría de los pacientes considera que se ha solucionado su problema de salud y volvería a ingresar en la UCEU (AU)

Aims: To assess patient satisfaction among those admitted into a short-stay emergency unit through a self-administered survey. Methods: The parameters included in the survey were: duration of emergency stay, quality of the emergency personnel, hostelery aspects, and written information provided on admission. The answer options were “very good”, “good”, “average” and “bad”. Patients were further questioned as to they considered that their health problem hab been solved and as to whether they would consider being again admitted into the same centre. Results: Eight hundred and fifty-four patients (451 males and 403 females) were admitted over the study period (mean age 71±15 years, mean stay 3.0±1.8 days). The patients completed 283 survey forms (30% of all admissions). The sojourn at the Emergency Ward, tha attitude of the health care personnel, the coordination among the various heath care specialists and the family visit times were rated as “very good” or “good” by 99% of the patients. The hostelery parameters, which were rated rather lower, show a clearly lower rating for the “level of noise in the Unit” (classed as “average” or “bad” by 44% of the patients). The information provided on admission was classed as “useful”. two hundred and fifteen patients (76%) considered that their problem hab been solved, and 246 (87%) would return and accept being admitted into the same short-stay emergency unit. Conclusions: The degree of satisfaction among patients at the shortstay emergency unit is quite high. Most patients consider that their health care problem has been solved and would again accept being admitted into such a unit (AU)

Influencia de la inflamación crónica prostática en muestras de biopsia sextante en los niveles séricos de PSA total y PSA libre / Role of chronic prostatic infiltrate from specimens of prostate biopsy in total and free PSA determination

Objetivo: Analizar la influencia en los niveles séricos de PSA total (PSAt) y PSA libre (PSAl) de los signos de inflamación crónica detectados mediante biopsia prostática en pacientes no sintomáticos. Pacientes y método: Seleccionamos 518 pacientes asintomáticos sometidos a ecografía transrectal y biopsia sextante de próstata por PSAt > 4 ng/mL y/o tacto rectal sugestivo de malignidad. Seleccionamos aquellos pacientes en los que la biopsia descartaba malignidad. Se definieron dos grupos, pacientes con lesión benigna de próstata (LBP) y pacientes con infiltrado inflamatorio crónico(SIC).Resultados: En 456 pacientes (88,03%) la biopsia se realizó por elevación de PSAt o/y por tacto rectal sospechoso en 62 pacientes (11,97%). El volumen medio prostático en pacientes con LBP fue54 cc, siendo 51 cc el volumen medio en pacientes con criterios histológicos de SIC. El PSAt medio en pacientes con LBP fue 9,43 (IC 95% ± 7,8) y 8,8 (IC 95% ± 5,73) en el grupo de SIC. Conclusiones: La presencia de SIC, no tiene influencia significativa en los valores PSAl y PSAt en la población estudiada. Estos hallazgos, a efectos de práctica clínica, permite en nuestro medio valorarlas cifras de PSA con independencia de la presencia de SIC en las muestras de biopsia (AU)

Purpose: To analyze the influence in total serum PSA (PSAt) and free PSA (PSAl) of chronic inflammatory patterns from prostate biopsy specimens of non-symptomatic patients. Patients and methods: 518 non-symptomatic patients underwent ultrasonography and prostatic biopsy for PSAt>4 ng/mL and/or DRE suspicious of malignancy. Those with a negative biopsy were divided into two subgroups: patients with benign prostatic lesions (LBP) and patients with chronic inflammatory signs (SIC).Results: 456 patients (88.03%) were biopsied for elevated PSAt or/and DRE suspicious of malignancy in 62 patients (11.97%). Mean volume in patients with LBP was 54cc, while 51cc was the mean volume in patients with histological pattern of chronic inflammatory infiltrate. Mean PSAt in patients with LBP was 9.43 (IC 95% ± 7.8) and 8.8 (IC 95% ± 5.73) in SIC’s group patients. Conclusions: The presence of SIC has no significant influence in the eventual value of PSAl y PSAt in a selected population. As a result of that finding data from serum PSA can be reliably evaluated even in the presence of SIC in biopsy specimens (AU)

[Secondary vesical amyloidosis]. / Amiloidosis vesical secundaria.

The bladder involvement is a very unusual fact in systemic amyloidosis. The distinction of primary and systemic amyloidosis disease with bladder involvement (secondary bladder amyloidosis) is important to the urologist. Secondary amyloidosis of the bladder is a rare disease entity (approximately 20 cases published). We document a case of a woman with a large history of rheumatoid arthritis who developed severe macrohematuria. Diagnosis was done by biopsy that revealed amyloidosis, and it was confirmed with an immunohistochemical staining of the specimens that defined the process as amyloid AA (secondary amyloidosis).

Amiloidosis vesical secundaria / Secondary bladder amyloidosis

La afectación vesical en la amiloidosis es un hecho poco frecuente, pudiendo distinguir entre formas primarias de amiloidosis vesical y formas de amiloidosis sistémica con afectación vesical (amiloidosisvesical secundaria), lo cual es importante para el urólogo. Ésta constituye una entidad patológica muy infrecuente, en base a la escasez de referencias en la literatura (estimamos que el número de casos de amiloidosis vesical secundaria comunicado no supera los 20). El caso que presentamos corresponde a una amiloidosis vesical secundaria en el seno de una artritis reumatoide de larga evolución, que debutó con hematuria severa. Señalamos la importancia que la inmunohistoquímia representa para el diagnóstico (AU)

The bladder involvement is a very unusual fact in systemic amyloidosis. The distinction of primary and systemic amyloidosis disease with bladder involvement (secondary bladder amyloidosis) is important to the urologist. Secondary amyloidosis of the bladder is a rare disease entity (approximately 20 cases published). We document a case of a woman with a large history of rheumatoid arthritis who developed severe macrohematuria. Diagnosis was done by biopsy that revealed amyloidosis, and it was confirmed with an immunohistochemical staining of the specimens that defined the process as amyloid AA (secondary amyloidosis) (AU)

[Pyeloureteral fungus ball in patients with urinary lithiasis. Treatment with ureterorenoscopy]. / Fungus ball pieloureteral en pacientes con litiasis urinaria. Tratamiento con ureterorrenoscopia.

INTRODUCTION: C. albicans is the most frequent fungus causing opportunist infections of the urinary tract. Agglutination of necrotic tissue nucleus (papilary necrosis), mucosus debri and chirurgic or lithiasic debri, originates a fungus ball, which can obstruct the urinary tract at any level. CLINICAL DATA: We present 2 patients with obstructive urinary lithiasis developing fungus ball in the dilated upper urinary tract. Patient 1 was bilaterally affected and never had systemic symptoms. Treatment consisted of uretherorrenoscope for removal of fungus ball, bilateral urinary diversion and anphotericine B irrigations and systemic. Patient 2 developed a candidemia and was treated with systemic liposomal anphotericine B, uretherorrenoscopy with removal of ureteric calculus and fungus ball, and placement of a double J catheter and nephrostomy tube for anphotericine B irrigation. DISCUSSION: Urinary lithiasis is a risk factor for fungal infection of the upper urinary tract, provided there is no other predisponent factor for opportunistic fungal infections. Calculi facilitates fungal growth by means of obstruction and subsequent retrograde estasis and creating a nucleus for growth, aggregation and ramification of mycelium. The infection pathway is probably ascendent and may turn into fungemia and septicaemia. Systemic antimicotics, urinary diversion and local irrigations with antimicotics, and endourologic technics, are the three basic items in the treatment. Ureterorrenoscopy plays an important roll as a diagnostic and therapeutic tool as it may solve the obstruction and allows removal of fungus ball.

Fungus ball pieloureteral en pacientes con litiasis urinaria. Tratamiento con ureterorrenoscopia / Pyelo-ureteral fungus ball in patients with urinary lithiasis. Ureterorrenoscopic management

INTRODUCCIÓN: C. albicans es el hongo que con mayor frecuencia produce infecciones oportunistas del tracto urinario. Cuando las hifas se aglutinan alrededor de un núcleo de tejido necrótico (necrosis papilar), hebras mucosas, restos de suturas quirúrgicas y/o material litiásico, se forma una pelota fúngica que puede obstruir cualquier tramo del tracto urinario. CASOS CLÍNICOS: Presentamos dos pacientes formadores crónicos de cálculos que en ausencia de otros factores de riesgo para las infecciones fúngicas oportunistas, desarrollan fungus balls en el tracto urinario superior dilatado por una litiasis ureteral obstructiva. La paciente 1 tuvo afectación bilateral y en ningún momento hubo manifestaciones sistémicas. El tratamiento consistió en ureterorrenoscopia con extracción de las bolas fúngicas, derivación bilateral y anfotericina B sistémica y en irrigaciones tópicas. El paciente 2, en el contexto de una sepsis candidiásica, se trató con anfotericina B sistémica, desobstrucción mediante ureterorrenoscopia con extracción de un cálculo ureteral y de pelotas fúngicas, y colocación de catéter JJ y nefrostomía con irrigaciones de anfotericina B.DISCUSIÓN: La litiasis urinaria constituye por sí sola un factor de riesgo para la infección fúngica del tracto urinario superior, en ausencia de otros factores favorecedores de las infecciones fúngicas oportunistas. El mecanismo por el cual el cálculo favorece el crecimiento de los hongos es, por un lado, la obstrucción pieloureteral con éstasis retrógrado y, por otro lado, la nucleación alrededor de una matriz de material cálcico sobre la que crecen, se agregan y se ramifican los micelios. La vía de infección es probablemente ascendente y puede complicarse con funguemia y sepsis. Los antimicóticos sistémicos, la derivación con catéteres ureterales o de nefrostomía que permitan irrigación local con antifúngicos, y las técnicas endourológicas, constituyen los tres pilares básicos del tratamiento. La ureterorrenoscopia juega aquí un papel importante al ser una técnica diagnóstica y al mismo tiempo terapéutica al permitir la desobstrucción litiásica y la limpieza de las masas fúngicas (AU)

INTRODUCTION: C. albicans is the most frequent fungus causing opportunist infections of the urinary tract. Agglutination of necrotic tissue nucleus (papilar necrosis), mucosus debri and chirurgic or lithiasic debri, originates a fungus ball, which can obstruct the urinary tract at any level. CLINICAL DATA: We present 2 patients with obstructive urinary lithiasis developing fungus ball in the dilated upper urinary tract. Patient 1 was bilaterally affected and never had systemic symptoms. Treatment consisted of uretherorrenoscope for removal of fungus ball, bilateral urinary diversion and anphotericine B irrigations and systemic. Patient 2 developed a candidemia and was treated with systemic liposomal anphotericine B, uretherorrenoscopy with removal of ureteric calculus and fungus ball, and placement of a double J catheter and nephrostomy tube for anphotericine B irrigation. DISCUSSION: Urinary lithiasis is a risk factor for fungal infection of the upper urinary tract, provided there is no other predisponent factor for opportunistic fungal infections. Calculi facilitates fungal growth by means of obstruction and subsequent retrograde estasis and creating a nucleus for growth, aggregation and ramification of mycelium. The infection pathway is probably ascendent and may turn into fungemia and septicaemia. Systemic antimicotics, urinary diversion and local irrigations with antimicotics, and endourologic technics, are the three basic items in the treatment. Ureterorrenoscopy plays an important roll as a diagnostic and terapeutic tool as it may solve the obstruction and allows removal of fungus ball (AU)