Does 8 Weeks of Integrated Functional Core and Plyometric Training Improve Postural Control Performance in Young Rhythmic Gymnasts?

It has been suggested that core stability and plyometric training (CPT) can enhance athletes' postural control. Nevertheless, the effects of an integrated core and plyometric training program on rhythmic gymnastics (RG) performance are unclear. This study aimed to evaluate the effects of an integrated functional CPT program on young rhythmics gymnasts' postural performance. A sample of 44 young female rhythmic gymnasts from a competitive team (age = 10.5 ± 1.8 years) participated in the study. The subjects were randomly divided into a control group and an experimental group. Pre- and posttest design was used. Postural control was assessed using single-leg stance tests and RG-specific balances over a force platform and evaluated by expert RG judges. The experimental group (n = 23) completed an 8-week functional CPT program based on RG technical requirements. Meanwhile, the control group (n = 21) received their usual training sessions. A mixed model of analysis of variance was applied to evaluate the effects of an intrasubject factor and an intersubject factor on each of the dependent variables. After 8 weeks, the experimental group obtained significant better results in some variables of the right support leg with eyes open and left support leg with eyes open single-leg support (p < .01), improvements were also found in some specific RG balances: Arabesque measured on the force platform (p < .01) and the side leg with help balance scored by the judges (p < .01). In conclusion, an integrated functional CPT program improved postural control in young rhythmic gymnasts. Coaches should consider using this CPT to improve RG performance.

The Effect of Eight-Week Functional Core Training on Core Stability in Young Rhythmic Gymnasts: A Randomized Clinical Trial.

It is suggested that core stability (CS) might improve rhythmic gymnasts' performance. Nevertheless, the effect of core stability training (CST) in CS performance is not clear. Purpose: Evaluating the effect of an eight-week functional CST on young rhythmics gymnasts' CS performance. Method: A sample of 45 young female rhythmic gymnasts from a competitive team (age = 10.5 ± 1.8 years, height = 144.1 ± 10.6 cm, weight 38.2 ± 8.9 kg, peak height velocity (PHV) = 12.2 ± 0.6 years) participated in the study. The participants were randomly allocated into the control group (CG) and experimental group (EG) and completed pre-tests and post-tests of specific CS tests using a pressure biofeedback unit (PBU). The CS was assessed by the bent knee fall out (BKFO), the active straight leg raise (ASLR) tests and the pelvic tilt test, all performed on the right and left sides. The EG (n = 23) performed an eight-week functional CST program based on rhythmic gymnastics (RG) technical requirements added to the traditional RG training sessions. Meanwhile, the CG (n = 22) received the traditional RG training sessions. Results: Mixed model analysis showed non-significant interaction effects; however, the ANOVA omnibus test showed a time effect (p < 0.05) in right BKFO (F1,42 = 4.60; p = 0.038) and both pelvic tilt tests (right F1,42 = 22.01, p < 0.001; left F1,42 = 19.13, p < 0.001). There were non-significant interaction effects. The fixed effects estimated parameters for right BKFO showed that both groups had less pressure variation after intervention compared with pre-intervention (ß = −1.85 mmHg, 95%CI = [−3.54 to −0.16], t42 = −2.14, p = 0.038). Furthermore, the left pelvic tilt (ß = 37.0 s, 95%CI = [20.4 to 53.6], t42 = 4.37, p < 0.001) improved 8.9 s more than the right pelvic tilt (ß = 28.1 s, 95%CI = [16.3 to 39.8], t42 = 4.69, p < 0.001) considering both groups together. Conclusions: Adding a functional CST to regular training showed a trend in improving the performance of CS-related variables, which could help improve RG-specific performance. Coaches working with rhythmic gymnasts should consider adding a functional CST to regular training to improve CS performance leading to increased specific RG performance.

The Mediating Role of Vision in the Relationship between Proprioception and Postural Control in Older Adults, as Compared to Teenagers and Younger and Middle-Aged Adults.

The aim of this study is to analyze the mediating role of vision in the relationship between conscious lower limb proprioception (dominant knee) and bipedal postural control (with eyes open and closed) in older adults, as compared with teenagers, younger adults and middle-aged adults. METHODS: The sample consisted of 119 healthy, physically active participants. Postural control was assessed using the bipedal Romberg test with participants' eyes open and closed on a force platform. Proprioception was measured through the ability to reposition the knee at 45°, measured with the Goniometer Pro application's goniometer. RESULTS: The results showed an indirect relationship between proprioception and postural control with closed eyes in all age groups; however, vision did not mediate this relationship. CONCLUSIONS: Older adults outperformed only teenagers on the balance test. The group of older adults was the only one that did not display differences with regard to certain variables when the test was done with open or closed eyes. It seems that age does not influence performance on proprioception tests. These findings help us to optimize the design of training programs for older adults and suggest that physical exercise is a protective factor against age-related decline.

Opioid addiction and the cerebellum.

Opioid addiction has reached the epidemic status in the United States in recent years. A multitude of factors have contributed to an alarming increase in misuse and health issues related to these drugs. Although medications exist to treat some aspects of opioid addiction since long ago, relapse and fatality rates remain very high despite their long-term availability. Therefore, more research devoted to better understanding its neural substrates is needed to aid developing new treatment options. Interestingly, a number of studies show the cerebellum to be involved in the effects of opioids and addiction-related processes, though it is not usually regarded as part of the opioid addiction-related brain circuitry. This review provides a summary of cerebellar anatomy and synaptic organization, followed by discussing the studies reporting cerebellar involvement in opioid effects in animals and humans, and their possible role in opioid addiction. Additionally, future experimental approaches will be proposed. We hope this work will contribute considering the cerebellum as an integral part of the circuitry underlying opioid-related disorders.

The cerebellum under stress.

Stress-related psychiatric conditions are one of the main causes of disability in developed countries. They account for a large portion of resource investment in stress-related disorders, become chronic, and remain difficult to treat. Research on the neurobehavioral effects of stress reveals how changes in certain brain areas, mediated by a number of neurochemical messengers, markedly alter behavior. The cerebellum is connected with stress-related brain areas and expresses the machinery required to process stress-related neurochemical mediators. Surprisingly, it is not regarded as a substrate of stress-related behavioral alterations, despite numerous studies that show cerebellar responsivity to stress. Therefore, this review compiles those studies and proposes a hypothesis for cerebellar function in stressful conditions, relating it to stress-induced psychopathologies. It aims to provide a clearer picture of stress-related neural circuitry and stimulate cerebellum-stress research. Consequently, it might contribute to the development of improved treatment strategies for stress-related disorders.

The Cerebellum, THC, and Cannabis Addiction: Findings from Animal and Human Studies.

Cannabis is the third most used psychoactive drug worldwide. Despite being legally scheduled as a drug with high harm potential and no therapeutic utility in countries like the USA, evidence shows otherwise and legislative changes and reinterpretations of existing ambiguous laws make this drug increasingly available by legal means. Nevertheless, this substance is able to generate clear addiction syndromes in some individuals who use it, which are accompanied by brain alterations resembling those caused by other addictive drugs. Moreover, there is no available pharmacological treatment for this disorder. This fact motivates a deep study and comprehension of the neural basis of addiction-relevant cannabinoid effects. Interestingly, the cerebellum, a hindbrain structure which involvement in functions not related to motor control and planning is being increasingly recognized in the last decades, seems to be involved in the effects of addictive drugs and addiction-related processes and also presents a high density of cannabinoid receptors. Preclinical research on the involvement of the cerebellum in cannabis' effects has focused in the drug's motor incoordinating actions, potentially underestimating its participation in addiction. Therefore, this review addresses the studies reporting cerebellar involvement in cannabis effects both in experimental animals and human subjects and the possible relevance of these changes for addiction. Additionally, future experimental approaches will be proposed and hopefully this work will stimulate research on the cerebellum in cannabis addiction and help recognizing it as an important part of the neural circuitry affected in cannabis-related disorders.

Is there an "antisocial" cerebellum? Evidence from disorders other than autism characterized by abnormal social behaviours.

The cerebellum is a hindbrain structure which involvement in functions not related to motor control and planning is being increasingly recognized in the last decades. Studies on Autism Spectrum Disorders (ASD) have reported cerebellar involvement on these conditions characterized by social deficits and repetitive motor behavior patterns. Although such an involvement hints at a possible cerebellar participation in the social domain, the fact that ASD patients present both social and motor deficits impedes drawing any firm conclusion regarding cerebellar involvement in pathological social behaviours, probably influenced by the classical view of the cerebellum as a purely "motor" brain structure. Here, we suggest the cerebellum can be a key node for the production and control of normal and particularly aberrant social behaviours, as indicated by its involvement in other neuropsychiatric disorders which main symptom is deregulated social behaviour. Therefore, in this work, we briefly review cerebellar involvement in social behavior in rodent models, followed by discussing the findings linking the cerebellum to those other psychiatric conditions characterized by defective social behaviours. Finally, possible commonalities between the studies and putative underlying impaired functions will be discussed and experimental approaches both in patients and experimental animals will also be proposed, aimed at stimulating research on the role of the cerebellum in social behaviours and disorders characterized by social impairments, which, if successful, will definitely help reinforcing the proposed cerebellar involvement in the social domain.

The cerebellum in fear and anxiety-related disorders.

Fear and anxiety-related disorders are highly prevalent psychiatric conditions characterized by avoidant and fearful reactions towards specific stimuli or situations, which are disproportionate given the real threat such stimuli entail. These conditions comprise the most common mental disorder group. There are a high proportion of patients who fail to achieve remission and the presence of high relapse rates indicate the therapeutic options available are far from being fully efficient. Despite an increased understanding the neural circuits underlying fear and anxiety-related behaviors in the last decades, a factor that could be partially contributing to the lack of adequate therapies may be an insufficient understanding of the core features of the disorders and their associated neurobiology. Interestingly, the cerebellum shows connections with fear and anxiety-related brain areas and functional involvement in such processes, but explanations for its role in anxiety disorders are lacking. Therefore, the aims of this review are to provide an overview of the neural circuitry of fear and anxiety and its connections to the cerebellum, and of the animal studies that directly assess an involvement of the cerebellum in these processes. Then, the studies performed in patients suffering from anxiety disorders that explore the cerebellum will be discussed. Finally, we'll propose a function for the cerebellum in these disorders, which could guide future experimental approaches to the topic and lead to a better understanding of the neurobiology of anxiety-related disorders, ultimately helping to develop more effective treatments for these conditions.

Cerebellar perineuronal nets in cocaine-induced pavlovian memory: Site matters.

One of the key mechanisms for the stabilization of synaptic changes near the end of critical periods for experience-dependent plasticity is the formation of specific lattice extracellular matrix structures called perineuronal nets (PNNs). The formation of drug memories depends on local circuits in the cerebellum, but it is unclear to what extent it may also relate to changes in their PNN. Here, we investigated changes in the PNNs of the cerebellum following cocaine-induced preference conditioning. The formation of cocaine-related preference memories increased expression of PNN-related proteins surrounding Golgi inhibitory interneurons as well as that of cFos in granule cells at the apex of the cerebellar cortex. In contrast, the expression of PNNs surrounding projection neurons in the medial deep cerebellar nucleus (DCN) was reduced in all cocaine-treated groups, independently of whether animals expressed a preference for cocaine-related cues. Discriminant function analysis confirmed that stronger PNNs in Golgi neurons and higher cFos levels in granule cells of the apex might be considered as the cerebellar hallmarks of cocaine-induced preference conditioning. Blocking the output of cerebellar granule cells in α6Cre-Cacna1a mutant mice prevented re-acquisition, but not acquisition, of cocaine-induced preference conditioning. Interestingly, this impairment in consolidation was selectively accompanied by a reduction in the expression of PNN proteins around Golgi cells. Our data suggest that PNNs surrounding Golgi interneurons play a role in consolidating drug-related memories.

The cerebellum in drug craving.

Craving has been considered one of the core features of addiction. It can be defined as the urge or conscious desire to use a drug elicited by the drug itself, drug-associated cues or stressors. Craving plays a major role in relapse, even after prolonged periods of abstinence, as well as in the maintenance of drug seeking in non-abstinent addicts. The circuitry of craving includes medial parts of the prefrontal cortex, ventral striatal zones, ventral tegmental area, ventral pallidum, and limbic regions. Interestingly, the cerebellum shows reciprocal loops with many of these areas. The cerebellum has been linked traditionally to motor functions but increasing evidence indicates that this part of the brain is also involved in functions related to cognition, prediction, learning, and memory. Moreover, the functional neuroimaging studies that have addressed the study of craving in humans repeatedly demonstrate cerebellar activation when craving is elicited by the presentation of drug-related cues. However, the role of cerebellar activity in these craving episodes remains unknown. Therefore, the main goal of this review is to provide a brief update on craving studies and the traditional neural basis of this phenomenon, and then discuss and propose a hypothesis for the function of the cerebellum in craving episodes.

The cloud paradigm applied to e-Health.

BACKGROUND: Cloud computing is a new paradigm that is changing how enterprises, institutions and people understand, perceive and use current software systems. With this paradigm, the organizations have no need to maintain their own servers, nor host their own software. Instead, everything is moved to the cloud and provided on demand, saving energy, physical space and technical staff. Cloud-based system architectures provide many advantages in terms of scalability, maintainability and massive data processing. METHODS: We present the design of an e-health cloud system, modelled by an M/M/m queue with QoS capabilities, i.e. maximum waiting time of requests. RESULTS: Detailed results for the model formed by a Jackson network of two M/M/m queues from the queueing theory perspective are presented. These results show a significant performance improvement when the number of servers increases. CONCLUSIONS: Platform scalability becomes a critical issue since we aim to provide the system with high Quality of Service (QoS). In this paper we define an architecture capable of adapting itself to different diseases and growing numbers of patients. This platform could be applied to the medical field to greatly enhance the results of those therapies that have an important psychological component, such as addictions and chronic diseases.

A user-friendly web portal for T-Coffee on supercomputers.

BACKGROUND: Parallel T-Coffee (PTC) was the first parallel implementation of the T-Coffee multiple sequence alignment tool. It is based on MPI and RMA mechanisms. Its purpose is to reduce the execution time of the large-scale sequence alignments. It can be run on distributed memory clusters allowing users to align data sets consisting of hundreds of proteins within a reasonable time. However, most of the potential users of this tool are not familiar with the use of grids or supercomputers. RESULTS: In this paper we show how PTC can be easily deployed and controlled on a super computer architecture using a web portal developed using Rapid. Rapid is a tool for efficiently generating standardized portlets for a wide range of applications and the approach described here is generic enough to be applied to other applications, or to deploy PTC on different HPC environments. CONCLUSIONS: The PTC portal allows users to upload a large number of sequences to be aligned by the parallel version of TC that cannot be aligned by a single machine due to memory and execution time constraints. The web portal provides a user-friendly solution.

Single port access sleeve gastrectomy: Is it reasonable?

This short letter is in response to the article published in your publication about single-incision laparoscopic bariatric surgery, by Chih-Kun Huang. We want to focus on the technical aspects.

Estrategias para mejorar el cribado de síndrome de Down: experiencia en el Instituto Dexeus (Barcelona) / Strategies to improve Down syndrome screening program: the experience at Dexeus Institut (Barcelona)

Objetivo. evaluar la mejora en la efectividad del cribado de trisomía 21 (T21) desde la implementación del programa y en función de las distintas estrategias empleadas. Material y métodos. hemos realizado un cribado temprano de T21 en todas las gestaciones únicas atendidas en nuestro centro desde octubre del 2003 hasta noviembre del 2009, combinando la edad materna, la medición de la translucencia nucal (TN) y la determinación de los marcadores bioquímicos de proteína plasmática A asociada al embarazo (PAPP-A) y β-gonadotropina coriónica humana libre (β-hCG). Desde octubre de 2008 se ha incorporado la medición del índice de pulsatilidad del ductus venoso (IPDV) en el cálculo del índice de riesgo. Los parámetros bioquímicos se han determinado mediante el analizador Kryptor, en una estrategia en un tiempo (determinación analítica y ecográfica el mismo día) o en dos tiempos (determinación analítica entre 2 y 4 semanas previas a la medición de la TN). El cálculo del índice de riesgo combinado de T21 se ha efectuado mediante el programa comercializado SsdwLab5-Software. Resultados. se incluye un total de 13.132 gestaciones, con 61 casos de T21. Se describen las curvas propias de normalidad de parámetros bioquímicos y ecográficos. Desde el año 2003 se han ido incorporando diferentes estrategias a fin de mejorar la efectividad del cribado de síndrome de Down (SD), las cuales permiten observar una mejoría de la tasa de detección (TD) (84,4 frente a 100%) y una reducción de la tasa de falsos positivos (TFP) (5,8 frente a 3,6%). Asumiendo una TD del 85%, la TFP desciende significativamente del 7,6 al 1,3%. Conclusiones. nuestra experiencia refleja una efectividad mayor del cribado de SD si disponemos de curvas propias de normalidad de los parámetros bioquímicos, actualizamos periódicamente sus valores de normalidad, realizamos el cribado en una estrategia en dos tiempos e incorporamos el valor del IPDV como parámetro de primera línea en el cálculo del índice de riesgo. Sugerimos incorporar estas estrategias en el cribado estándar de T21 en centros con experiencia con el fin de reducir las pruebas invasivas innecesarias(AU)

Objective. To evaluate the improvement in the effectiveness of trisomy 21 (T21) screening according to the different strategies employed. Material and methods. An early T21 screening was performed on all single pregnancies from October 2003 to November 2009, combining maternal age, the measurement of nuchal translucency (NT), and the determination of the biochemical markers, pregnancy- associated plasma protein A (PAPP-A) and free human chorionic gonadotropin (β-hCG). Measurement of the ductus venosus pulsatility index (DVPI) has been included in the assessment of the risk index since October 2008. The biochemical parameters were measured using the Kryptor analyser, in a one time (analytical determinations and ultrasound on the same day) or a two time strategy (analytical determinations between 2 and 4 weeks prior to the measurement of NT). The calculation of the combined T21 risk index was performed using the program marketed by SsdwLab5-Software. Results. A total of 13,132 pregnancies were included, with 61 cases of T21. Distribution curves of the biochemical and ultrasound parameters are described. Different strategies have been introduced since 2003 with the purpose of improving the effectiveness of Down's syndrome (DS) screening. These have led to an improvement in the detection rate (DR) (84.4% to 100%), and a reduction in the false positive rate (FPR) (5.8% to 3.6%). Assuming a DR of 85%, the FPR have significantly decreased from 7.6% to 1.3%. Conclusions. The effectiveness of SD screening improves when we use our own distribution curves of the biochemical parameters available, we periodically update their values, when we move from one to two-time screening strategy, and incorporate the DVPI as a first line parameter in the assessment of the risk index. We suggest including these strategies in the standard T21 screening policies in experienced centres in order to reduce unnecessary invasive tests(AU)

Do geographic and educational factors influence the quality of life in rectal cancer patients with a permanent colostomy?

PURPOSE: This study was designed to evaluate possible social and geographic factors that could have an impact on quality of life in patients after abdominoperineal excision of the rectum. Although the number of patients with rectal cancer who need to be treated with abdominoperineal excision of the rectum and construction of permanent colostomy has greatly decreased in the past, there is still controversy about the influence on quality of life caused by this procedure. METHODS: In a prospective trial, patients operated on for low rectal cancer by abdominoperineal excision of the rectum were evaluated by a quality of life questionnaire, modified from The American Society of Colon and Rectal Surgeons questionnaire, to assess fecal incontinence. The results for the four domains of quality of life (lifestyle, coping behavior, embarrassment, depression), as well as for subjective general health, were evaluated with regard to age, gender, education, and geographic origin in univariate and multivariate analyses. RESULTS: Thirteen institutions in 11 countries included data from 257 patients. Although the analysis of general health did not reveal any significant differences, the analysis of the four quality of life domains showed the significant influence of geographic origin. The presence of a permanent colostomy showed a consistently negative impact on patients in southern Europe as well as for patients of Arabic (Islamic) origin. On the other hand, age, gender, and educational status did not reveal a statistically significant influence. CONCLUSIONS: This is the first study to show the influence of geographic origin on quality of life of patients with a permanent colostomy. Possible factors that may influence the outcome of patients after surgical treatment of rectal cancer, such as weather, religion, or culture, should be taken into account when quality of life evaluations are considered.

Laparoscopia colorrectal en Canarias. Estudio multicéntrico en 144 pacientes / Colorectal laparoscopy in the Canary Islands. A multicenter study of 144 patients

Introducción. Analizar los resultados a corto plazo de la cirugía laparoscópica colorrectal (CLCR) en Canarias. Material y métodos. Enviamos una encuesta a los hospitales que realizan esta actividad y obtuvimos retrospectivamente datos sobre las variables demográficas, peroperatorias y anatomopatológicas de 144 pacientes intervenidos de CLCR desde mayo de 1993 hasta mayo de 2003. Resultados. Se intervino quirúrgicamente a 65 varones y 79 mujeres, 68 (47,2%) en los últimos 16 meses del período estudiado. Se realizaron 126 procedimientos colónicos y 18 rectales. El procedimiento más realizado fue la sigmoidectomía, con 85 casos (59%). El adenocarcinoma, con 73 casos (50%), fue el diagnóstico más habitual, y la diverticulosis, con 36 casos (25%), fue el segundo en frecuencia. Los valores medios de las variables estudiadas fueron: índice de masa corporal medio, 27,3 (rango, 22-35); tiempo quirúrgico, 175 min (rango, 60-255), y pérdidas hemáticas, 183,6 ml (rango, 50-500). La peristalsis se presentó a las 45 h, la dieta oral se inició a las 67 h y la estancia hospitalaria media global fue de 7,8 días (rango, 3-30). Los pacientes que presentaban complicaciones tuvieron una estancia significativamente mayor (14,5 frente a 6,4 días; p < 0,01). Hubo 7 conversiones (4,86%). No se registró ninguna muerte. La tasa de morbilidad global fue del 28%. La complicación precoz más frecuente fue la infección de la herida en 9 ocasiones (6,2%). Se detectaron 5 casos de fuga anastomótica (3,4%). Conclusiones. La CLCR se ha mostrado como una técnica segura y eficaz, y su uso se ha incrementado en todos los centros consultados en el último año. La aparición de complicaciones posquirúrgicas fue el factor que más influyó en la estancia hospitalaria (AU)

Introduction. To analyze the short-term results of laparoscopic colorectal surgery (LCRS) in the Canary Islands. Material and methods. A questionnaire was sent to hospitals performing laparoscopy and retrospective data on demographic, perioperative and pathological variables in 144 patients who underwent LCRS between May 1993 and May 2003 were obtained. Results. Sixty-five men and 79 women underwent colon (n=126) and rectal (n=18) surgery in the last 16 months of the study period. The most frequently performed procedure was sigmoidectomy in 85 patients (59%). The most frequent diagnosis was colon adenocarcinoma in 73 patients (50%), followed by diverticular disease in 36 patients (25%). The mean values of the variables studied were: body mass index, 27.3 (range, 22-35); operating time, 175 min (range, 60-255); blood loss, 183.6 ml (range, 50-500). Peristalsis reinitiated at 45 h; oral diet was introduced at 67 h and the overall mean length of hospital stay was 7.8 days (range, 3-30). The length of hospital stay was significantly longer in patients with complications (14.5 vs 6.4; p <.01). There were 7 conversions (4.86%). There were no perioperative deaths. The overall morbidity rate was 28%. The most frequent early complication was surgical wound infection in 9 patients (3.4%). Conclusions. LCRS has been shown to be a safe and effective technique that has recently increased in the centers surveyed. The factor with the greatest influence on length of hospital stay was the development of postoperative complications (AU)

[Colorectal laparoscopy in the Canary Islands. A multicenter study of 144 patients]. / Laparoscopia colorrectal en Canarias. Estudio multicéntrico en 144 pacientes.

INTRODUCTION: To analyze the short-term results of laparoscopic colorectal surgery (LCRS) in the Canary Islands. MATERIAL AND METHODS: A questionnaire was sent to hospitals performing laparoscopy and retrospective data on demographic, perioperative and pathological variables in 144 patients who underwent LCRS between May 1993 and May 2003 were obtained. RESULTS: Sixty-five men and 79 women underwent colon (n=126) and rectal (n=18) surgery in the last 16 months of the study period. The most frequently performed procedure was sigmoidectomy in 85 patients (59%). The most frequent diagnosis was colon adenocarcinoma in 73 patients (50%), followed by diverticular disease in 36 patients (25%). The mean values of the variables studied were: body mass index, 27.3 (range, 22-35); operating time, 175 min (range, 60-255); blood loss, 183.6 ml (range, 50-500). Peristalsis reinitiated at 45 h; oral diet was introduced at 67 h and the overall mean length of hospital stay was 7.8 days (range, 3-30). The length of hospital stay was significantly longer in patients with complications (14.5 vs 6.4; p <.01). There were 7 conversions (4.86%). There were no perioperative deaths. The overall morbidity rate was 28%. The most frequent early complication was surgical wound infection in 9 patients (6.2%). Anastomotic leak was detected in 5 patients (3.4%). CONCLUSIONS: LCRS has been shown to be a safe and effective technique that has recently increased in the centers surveyed. The factor with the greatest influence on length of hospital stay was the development of postoperative complications.

Estimulación de raíces sacras como tratamiento de la incontinencia fecal. Resultados preliminares / Sacral nerve stimulation in the treatment of fecal incontinence. Preliminary results

Introducción. Los defectos funcionales de la musculatura esfinteriana del canal anal, sin defectos estructurales aparentes, conllevan en muchas ocasiones incontinencia en forma de urgencia e incluso incontinencia insensible. En consecuencia, los pacientes presentan déficit importantes en su calidad de vida. El presente estudio muestra los resultados obtenidos en 9 pacientes con incontinencia fecal que han recibido estimulación de las raíces sacras (ERS) de forma permanente. Pacientes y método. Se incluyó a pacientes con incontinencia de más de un episodio a la semana y esfínter anal externo normal por ecografía (intacto o reparado). En todos ellos, el tratamiento médico previo había fallado, así como la terapia de biofeedback. En una primera fase los pacientes recibieron estimulación percutánea. En caso de presentar una reducción mínima del 50 por ciento en los episodios de incontinencia, el paciente fue candidato a implante del electrodo definitivo, así como de un generador de impulsos que se colocó en el espacio subcutáneo y que mantuvo la estimulación de forma continua. El seguimiento se realizó al mes y a los 3, 6 y 12 meses. En él se incluyó un diario de incontinencia (21 días), una manometría anal y un estudio de la calidad de vida (CV) mediante cuestionarios (SF-36 y el de la American Society of Colorectal Surgeons [ASCRS]), realizados en cada seguimiento. Resultados. Entre junio de 1999 y septiembre de 2002 se testó a 18 pacientes y se incluyó en el estudio a los nueve que fueron candidatos a implante definitivo, es decir, que completaron la terapia. Las pacientes (todas ellas mujeres) tenían una edad media de 53,1 años (rango, 37-65 años). El diario basal de incontinencia mostró en una media de 10,2 ñ 6,2 episodios de incontinencia a la semana. Se evidenció una reducción de la incontinencia media del 81 por ciento a los 6 meses (p < 0,0001), y se mantuvo la mejoría al año de seguimiento. Asimismo, se observó una mejoría significativa en la CV de las pacientes. Conclusiones. La ERS resulta una terapia eficaz para la reducción del número de episodios de incontinencia en las pacientes con incontinencia fecal funcional. La mejoría en la continencia tiene un efecto directamente relacionado con el incremento de calidad de vida de las pacientes (AU)

Sacral spinal nerve stimulation for faecal incontinence: multicentre study.

BACKGROUND: In patients with faecal incontinence in whom conservative treatment fails, options are limited for those with a functionally deficient but morphologically intact sphincter. We investigated the effect of sacral nerve stimulation on continence and quality of life. METHODS: In this multicentre prospective trial, 37 patients underwent a test stimulation period, followed by implantation of a neurostimulator for chronic stimulation in 34. Effect on continence was assessed by daily bowel-habit diaries over a 3-week period and on quality of life by the disease-specific American Society of Colon and Rectal Surgeons (ASCRS) questionnaire and the standard short form health survey questionnaire (SF-36). Every patient served as his or her own control. FINDINGS: Frequency of incontinent episodes per week fell (mean 16.4 vs 3.1 and 2.0 at 12 and 24 months; p<0.0001) for both urge and passive incontinence during median follow-up of 23.9 months. Mean number of days per week with incontinent episodes also declined (4.5 vs 1.4 and 1.2 at 12 and 24 months, p<0.0001), as did staining (5.6 vs 2.4 at 12 months; p<0.0001) and pad use (5.9 vs 3.7 at 12 months; p<0.0001). Ability to postpone defecation was enhanced (at 12 months, p<0.0001), and ability to completely empty the bowel was slightly raised during follow-up (at 12 months, p=0.4122). Quality of life improved in all four ASCRS scales (p<0.0001) and in seven of eight SF-36 scales, though only social functioning was significantly improved (p=0.0002). INTERPRETATION: Sacral nerve stimulation greatly improves continence and quality of life in selected patients with morphologically intact or repaired sphincter complex offering a treatment for patients in whom treatment options are limited.

Preparacion mecánica preoperatoria del colon. Estudio prospectivo, aleatorio, simple ciego, comparativo entre fosfato sódico y polietilenglicol / Preoperative mechanical preparation of the colon. A prospective, randomized, single-blind study of sodium phosphate vs polyethylene glycol

Objetivo. Valorar la seguridad, la efectividad y la tolerancia del fosfato sódico (NaP) y el polietilenglicol (PEG) en la preparación para la cirugía colorrectal. Pacientes y métodos. Cincuenta pacientes fueron prospectivamente aleatorizados, ingiriendo 90 ml de NaP o 4 l de PEG el día anterior a la cirugía. La seguridad del preparado se valoró con un análisis previo y tras la administración. En un detallado cuestionario los pacientes valoraron la facilidad de cumplimiento, la cantidad de fármaco ingerida, las molestias asociadas y el sabor; si habían recibido un preparado previo, valoraron la dificultad en completar la pauta, el grado de malestar y el sabor. La eficacia fue valorada por el cirujano abriendo la pieza quirúrgica. El estudio estadístico se realizó mediante la prueba de la U de Mann Whitney y el test de Shapiro-Wilk. Resultados. Se apreció una mayor facilidad de cumplimiento en el grupo NaP con una significación estadística de p = 0,0001. El grado de cumplimiento de la preparación fue mayor en el grupo NaP (97,20 ñ 10,6) respecto al PEG (90,21 ñ16,4) (p = 0,034). No hubo diferencias en el grado de malestar ni en las molestias asociadas al preparado evacuante (p = 0,45). De los pacientes que habían recibido preparación para colonoscopia, los del grupo NaP tuvieron una menor dificultad en completar el tratamiento y en el grado de malestar (p < 0,001). No hubo diferencias en el sabor del producto (p = 0,4) ni en el grado de limpieza conseguido. El grupo NaP presentó un incremento en los valores de fósforo previo (3,4 ñ 0,7) respecto a la determinación posterior a la ingesta de evacuante (4,2 ñ 0,9) y un descenso en los valores de calcio tras la ingesta de NaP (9,4 ñ 0,4 frente a 8,9 ñ 0,2), ambos con significación estadística (p = 0,01 y p = 0,02, respectivamente), sin repercusión clínica. Se observó un descenso en los valores de potasio en ambos grupos (NaP, 4,3 ñ 0,4; PEG, 3,8 ñ 0,4), con significación estadística (p = 0,01), aunque sin repercusión clínica. En ningún caso se describieron reacciones adversas. Conclusiones. Ambas soluciones son efectivas y seguras. La solución de NaP tiene una facilidad, un grado de cumplimiento y un grado de aceptación mayores que el PEG. Se ha observado una hiperfosfatemia e hipocalcemia estadísticamente significativa en el grupo NaP sin repercusiones clínicas. (AU)