Animal model assessment of a new design for a coated mitomycin-eluting biodegradable ureteral stent for intracavitary instillation as an adjuvant therapy in upper urothelial carcinoma.

BACKGROUND: A major limitation in the treatment of upper urinary tract urothelial carcinoma is the limited use of adjuvant therapy due to the drawbacks of current techniques for intracavitary instillation. The aim was to assess, in a large animal model, a biodegradable ureteral stent coated with silk fibroin for mitomycin release, i.e. BraidStent-SF-MMC. METHODS: A total of 14 female pigs with a solitary kidney underwent initial urinalysis, blood chemistry, nephrosonographic, and contrast fluoroscopy assessment of the urinary tract. Later, the BraidStent-SF-MMC was placed retrogradely to assess the mitomycin urine concentration from 0-48 hours. Follow-up was performed weekly until complete stent degradation to assess the macroscopic and microscopic changes in the urinary tract, stent complications. RESULTS: The drug eluting stent released mitomycin for the first 12 h. The main complication was the release of obstructive ureteral coating fragments during the first to third week in 28.5 and 7.1% of animals, respectively, related to urinary pH<7.0, which destabilized the stent coating. Another complication was ureteral strictures between the fourth and sixth week in 21%. The stents were completely degraded by 6-7 weeks. There were no stent-related systemic toxic effects. The success rate was 67.5% and the complication rate was 25.7%. CONCLUSIONS: For the first time, we have shown that a biodegradable anti-cancer drug eluting stent, BraidStent-SF-MMC, provides controlled and well-tolerated release of mitomycin into the upper urinary tract in an animal model. Mitomycin release from a silk fibroin coating could be a compelling approach for adjuvant chemotherapy instillation in upper tract urothelial carcinoma management.

[Renal harvest. State of the art.] / Extracción renal. Situación actual.

Kidney transplantation (KT) is the best treatment for end-stage renal disease. Despite Spain isone of the leading countries in donation, the need for transplantable organs exceeds the available supply. Graft survival depends on the quality of the organ, the damage it suffers during the donation and transplantation process, as well as the risk of rejection. Among the factors that must be controlled and minimized are the ischemia-reperfusion injuries that occurs in the moments surrounding the death of the donor, the procurement and the preservation of the organ until kidney transplantation. Static cold storage is the traditional method of preservation of the organ until the moment of implantation, since it is a technique with wide availability and low cost. The use of perfusion machines in DCD and expanded criteria has shown better short-term results (primary failur delayed on set of function) without affecting recipient orgraft survival. The objective of our article is to review the current situationand the resources available to increase the pool of transplantable organs and their quality. We conducted a systematic review on kidney extraction, donor management, preservation methods and techniques to optimize cadaveric donor kidney donation.

El trasplante renal (TR) es el mejor tratamiento para la enfermedad renal crónica terminal. En España no se dispone de suficientes órganos para suplirla demanda de pacientes en lista de espera a pesar deser uno de los países líderes en donación. La supervivencia del injerto depende de la calidad delórgano, el daño que sufre durante el proceso de donacióny trasplante, así como de la posibilidad de que seproduzca rechazo. Entre los factores que debemos minimizar y optimizar se encuentran las lesiones inducidas por los mecanismos de isquemia-reperfusión, en los momentos que rodean la muerte del donante, la extracción y la preservación del órgano hasta su trasplante.Tradicionalmente la preservación del órgano hasta elmomento del implante se ha llevado a cabo mediante la conservación en frío, ya que es una técnica con amplia disponibilidad y bajo coste. El uso de máquinas de perfusiónen donaciones en asistolia y criterio expandido,ha demostrado mejores resultados a corto plazo (fallo primario, inicio retrasado de función) sin afectar a la supervivencia del receptor o del injerto. El objetivo de este trabajo es revisar la situación actual,así como los recursos disponibles para aumentar el poolde órganos trasplantables y la calidad de estos. Hemos realizado una revisión sobre la extracción renal, manejo del donante, métodos y técnicas de preservación para optimizar la donación renal de donante cadáver.

Extracción renal. Situación actual / Kidney extraction. Current situation

El trasplante renal (TR) es el mejor tratamiento para la enfermedad renal crónica terminal. EnEspaña no se dispone de suficientes órganos para suplirla demanda de pacientes en lista de espera a pesar deser uno de los países líderes en donación. La supervivencia del injerto depende de la calidad delórgano, el daño que sufre durante el proceso de donación y trasplante, así como de la posibilidad de que seproduzca rechazo. Entre los factores que debemos minimizar y optimizar se encuentran las lesiones inducidaspor los mecanismos de isquemia-reperfusión, en los momentos que rodean la muerte del donante, la extraccióny la preservación del órgano hasta su trasplante.Tradicionalmente la preservación del órgano hasta elmomento del implante se ha llevado a cabo mediante laconservación en frío, ya que es una técnica con amplia disponibilidad y bajo coste. El uso de máquinas de perfusión en donaciones en asistolia y criterio expandido,ha demostrado mejores resultados a corto plazo (falloprimario, inicio retrasado de función) sin afectar a lasupervivencia del receptor o del injerto. El objetivo de este trabajo es revisar la situación actual,así como los recursos disponibles para aumentar el poolde órganos trasplantables y la calidad de estos. Hemosrealizado una revisión sobre la extracción renal, manejodel donante, métodos y técnicas de preservación paraoptimizar la donación renal de donante cadáver.(AU)

Kidney transplantation (KT) is the besttreatment for end-stage renal disease. Despite Spain isone of the leading countries in donation, the need fortransplantable organs exceeds the available supply. Graft survival depends on the quality of the organ, thedamage it suffers during the donation and transplantation process, as well as the risk of rejection. Among the factors that must be controlled and minimized are the ischemia-reperfusion injuries that occursin the moments surrounding the death of the donor, theprocurement and the preservation of the organ until kidney transplantation.Static cold storage is the traditional method of preservation of the organ until the moment of implantation, sinceit is a technique with wide availability and low cost. Theuse of perfusion machines in DCD and expanded criteria has shown better short-term results (primary failure, delayed onset of function) without affecting recipient orgraft survival.The objective of our article is to review the current situation and the resources available to increase the pool oftransplantable organs and their quality. We conducted a systematic review on kidney extraction,donor management, preservation methods and techniques to optimize cadaveric donor kidney donation:(AU)

Thoracic Aortic Mural Thrombus, Right Ventricular Clot and Pulmonary Embolism in a Patient With COVID-19 Pneumonia.

Since the outbreak of the COVID-19 pandemic, increasing evidence suggests that infected patients present a high incidence of thrombotic complications. We report a 67-year-old-woman admitted for severe acute respiratory syndrome coronavirus 2 infection. Chest CT images showed bilateral ground glass opacities, bilateral pulmonary embolism, right ventricular clot in transit and 2 thoracic aortic mural thrombus. Therapy was initiated with subcutaneous low-molecular-weight heparin, and the patient was discharged at 20 days asymptomatic. Complete resolution of the aortic thrombus was observed in a 1-month surveillance CT angiogram. Our case illustrates vascular complications in a COVID-19 patient and its effective treatment with anticoagulation.

Cadaveric Models for Renal Transplant Surgery Education: a Comprehensive Review.

PURPOSE OF REVIEW: To evaluate the utility of cadaveric models for kidney transplant (KT) surgery training. RECENT FINDINGS: Medline® and PubMed® databases were searched for English and Spanish language articles published describing different learning models used in KT formation. We evaluated the use of cadavers preserved by Thiel's embalming method (TEM) as KT simulation models. Students were divided in groups of 4 people: four trainees mentored by an expert in KT surgery. Among the trainees were surgical residents and low-experience surgeons. A total of 39 TEM preserved bodies were used, of which 75 viable renal grafts were obtained. In each cadaver, two complete transplantation processes were performed, each consisting of en bloc nephrectomy with the trunk of aorta and inferior vena cava, bench surgery and perfusion with saline of the organ, and KT surgery. As with any surgical procedure, learning KT surgery is a stepwise process that requires years of dedication. The models available for the surgical simulation of KT surgery allow to practice and achieve dexterity in performing the procedure in a safe and reproducible way. Training on TEM-preserved corpses offers a highly realistic model for the surgical simulation of KT surgery.

Prevalencia de infección por genotipos del virus del papiloma humano en mujeres con atipia de células escamosas de significado incierto / Prevalence of infection by genotypes of the PVH in women with ASCUS cytology

Resumen OBJETIVO: Estimar la prevalencia de infección por genotipos del virus del papiloma humano en mujeres con atipia de células escamosas de significado incierto. MATERIALES Y MÉTODO: Estudio transversal, descriptivo y retrospectivo efectuado mediante el análisis de los registros de la prueba 21-PVH-Genoarray de Hybriobio en mujeres mayores de 18 años, referidas al servicio de Ginecología del Hospital Nacional Carlos Alberto Seguín, durante el año 2018, debido a atipia de células escamosas de significado incierto. Se utilizó el sistema Genoarray-Hybribio para el genotipado. Variables de estudio: genotipos de VPH de alto riesgo, VPH de bajo riesgo y edad. Se estimaron proporciones y razón de momios con IC95%. RESULTADOS: Se estudiaron 227 pacientes: 95 resultaron con prueba positiva para VPH (41.8%). La prevalencia de genotipos de alto riesgo fue de 33.9%. Los más frecuentes fueron: 16, 31, 52 y 53. La prevalencia fue de 4.8% para los genotipos de bajo riesgo: 81, 6, 43 y 11, y 3.1% fueron infecciones mixtas. Se registraron 38 mujeres con infección con al menos dos genotipos. Las mujeres mayores de 30 años tuvieron 3 veces más riesgo de infección por genotipos de alto riesgo. La razón de momios fue 3.32 (IC95%: 1.21-9.10) en relación con las menores de 30 años, asociación estadística significativa p < 0.01. CONCLUSIONES: La prevalencia global fue: 41.8%, la infección por VPH de alto riesgo en mujeres con atipia de células escamosas de significado incierto fue 33.9%. Los genotipos más prevalentes en infecciones únicas fueron: 16, 31, 52 y 53.

Abstract OBJECTIVE: To estimate the prevalence of infection by genotypes of the human papilloma virus in women with squamous cell atypia of unknown significance (ASCUS). MATERIALS AND METHOD: Transversal and cross-sectional study of patients referred to the Carlos Alberto Seguín National Hospital, during 2018, for presenting ASCUS cytology, the Genoarray-Hybribio system for genotyping was reported. The study variables were: high-risk HPV genotypes, low-risk HPV, and age. Proportions and odds ratios were estimated with 95% confidence intervals. RESULTS: 227 patients were studied, of which 95 had a positive test for HPV (41.8%). The prevalence for high-risk genotypes was 33.9%. The most frequent being 16, 31, 52 and 53. The prevalence was 4.8% for low-risk genotypes: 81, 6, 43, and 11, and 3.1% were mixed infections. 38 women had infection with less than two genotypes, women older than 30 years were 3 times more at risk of infection due to high-risk genotypes, Odss ratio 3.32 (95% CI 1.21-9.10) in relation to those younger than 30 years, statistical association significant p <0.01. CONCLUSIONS: The overall prevalence was 41.8%, the high-risk HPV infection in women with ASCUS was 33.9%, with the genotypes most prevalent in single infections being 16, 31, 52, and 53.

[Clinical and prognostic characteristics of the molecular subtypes of breast cancer determined by immunohistochemistry. Arequipa, Peru]. / Características clínicas y pronósticas de los subtipos moleculares de cáncer de mama determinados por inmunohistoquímica. Arequipa, Perú.

The objective of this study was to determine the clinical and prognostic characteristics of breast carcinomas according to the molecular subtype using immunohistochemical markers. The study included 280 women with unilateral breast cancer enrolled from 2009 to 2012. The carcinomas were classified into four subtypes based on immunohistochemical findings: luminal A, luminal B, HER2, and triple negative. The Kaplan-Meier test was used to determine the effect of histological type and molecular subtype on overall survival. Our results indicated that the most common breast carcinoma subtype was luminal A (105 cases, 37.5%), followed by luminal B (88 cases, 31.4%), HER2 (46 cases, 16.4%), and triple negative (41 cases, 14.6%). Luminal carcinomas were well-differentiated in most cases, without involvement of the axillary lymph nodes, and showed a similar tumor size and stage. In contrast, HER2 and triple-negative tumors were poorly differentiated in most cases, with axillary node involvement, and were associated with decreased overall survival.

Con el objetivo de determinar las características clínicas y pronósticas de los carcinomas de mama, según sus subtipos moleculares mediante la aplicación de marcadores de inmunohistoquímica, se realizó un estudio en 280 mujeres con cáncer infiltrante de mama unilateral, del 2009 al 2012. Se clasificó por técnicas de inmunohistoquímica en 4 subtipos: luminal A, luminal B, HER2 y triple negativo. Para determinar la influencia del tipo histológico y del subtipo molecular en la sobrevida global, se utilizó el método de Kaplan Meier. Se encontró que los carcinomas de mama fueron: luminal A con 105 (37,5%); luminal B con 88 (31,4%); carcinomas HER2 con 46 (16,4%), y triple negativo con 41 (14,6%). Se concluye que los carcinomas de tipo luminal fueron con mayor frecuencia tumores bien diferenciados, con ganglios axilares negativos, tamaño tumoral y estadio semejante; mientras que los tumores HER2 y triple negativo presentaron mayor proporción de tumores pobremente diferenciados, compromiso ganglionar axilar, y menor sobrevida global.

Características clínicas y pronósticas de los subtipos moleculares de cáncer de mama determinados por inmunohistoquímica. Arequipa, Perú / Clinical and prognostic characteristics of the molecular subtypes of breast cancer determined by immunohistochemistry. Arequipa, Peru

RESUMEN Con el objetivo de determinar las características clínicas y pronósticas de los carcinomas de mama, según sus subtipos moleculares mediante la aplicación de marcadores de inmunohistoquímica, se realizó un estudio en 280 mujeres con cáncer infiltrante de mama unilateral, del 2009 al 2012. Se clasificó por técnicas de inmunohistoquímica en 4 subtipos: luminal A, luminal B, HER2 y triple negativo. Para determinar la influencia del tipo histológico y del subtipo molecular en la sobrevida global, se utilizó el método de Kaplan Meier. Se encontró que los carcinomas de mama fueron: luminal A con 105 (37,5%); luminal B con 88 (31,4%); carcinomas HER2 con 46 (16,4%), y triple negativo con 41 (14,6%). Se concluye que los carcinomas de tipo luminal fueron con mayor frecuencia tumores bien diferenciados, con ganglios axilares negativos, tamaño tumoral y estadio semejante; mientras que los tumores HER2 y triple negativo presentaron mayor proporción de tumores pobremente diferenciados, compromiso ganglionar axilar, y menor sobrevida global.

ABSTRACT The objective of this study was to determine the clinical and prognostic characteristics of breast carcinomas according to the molecular subtype using immunohistochemical markers. The study included 280 women with unilateral breast cancer enrolled from 2009 to 2012. The carcinomas were classified into four subtypes based on immunohistochemical findings: luminal A, luminal B, HER2, and triple negative. The Kaplan-Meier test was used to determine the effect of histological type and molecular subtype on overall survival. Our results indicated that the most common breast carcinoma subtype was luminal A (105 cases, 37.5%), followed by luminal B (88 cases, 31.4%), HER2 (46 cases, 16.4%), and triple negative (41 cases, 14.6%). Luminal carcinomas were well-differentiated in most cases, without involvement of the axillary lymph nodes, and showed a similar tumor size and stage. In contrast, HER2 and triple-negative tumors were poorly differentiated in most cases, with axillary node involvement, and were associated with decreased overall survival.

Is There a New Alternative for a Safer Kidney Artery Ligation in Laparoscopic Donor Nephrectomy?

Controlled ligation and division of the renal hilum are critical steps during laparoscopic living donor nephrectomy. Major hemorrhage from technical failure, although an infrequent occurrence, can cause significant, yet preventable, morbidity or death. Polymer-secured nontransfixion clips are used worldwide for renal pedicle control during laparoscopic nephrectomy, but their use is contraindicated for renal artery ligation during laparoscopic living donor nephrectomy. Laparoscopic staplers are reliable transfixion systems for controlling kidney pedicle. However, stapler malfunction is not negligible, reaching up to 1.7%. A new double shank (DS) titanium-secured nontransfixion clip can dodge legal concerns on polymer-secured clips, while maintaining most of their advantages, without technical failures that may be seen in laparoscopic staplers. New alternatives must be proposed and explored to reach an agreement of the urological community. The new DS-titanium-secured clips could be a step forward toward a safer surgery for kidney donors, at least equivalent to hand ties to occlude the renal artery.

An experimental model for training in renal transplantation surgery with human cadavers preserved using W. Thiel's embalming technique.

OBJECTIVE: To describe a novel cadaver-based model for practicing renal transplant (RT) surgery. DESIGN: A simulating model using cadavers preserved by Thiel's method is developed to teach surgical anatomy and operative skills in RT surgery. Participants were asked to complete a voluntary, anonymous survey evaluating perceptions of the model and comparing cadaver sessions to other types of learning (rating questions from 0-10). SETTING: Large university teaching hospital. PARTICIPANTS: A total of 28 residents, junior transplant surgeons, and faculty members were participants in the cadaver simulation. RESULTS: Overall, 9 cadavers were used with 17 grafts transplanted. Kidney procurement in human cadavers preserved using Thiel's embalming technique was performed following the conventional protocol; en bloc nephrectomy with the trunk of aorta and inferior vena cava. Bench surgery was performed, perfusing artery with saline and checking vascular permeability. Once suitability is established, RT was performed as is done in clinical practice. This embalming method enables tissue dissection that is comparable to the living body and provides suitable conditions for realistic RT simulation; handling human tissues and vessels in the same surgical field as the clinical scenario. This experimental model approximates to in vivo RT, providing a realistic and interesting learning to inexperienced surgeons. Overall, participants held a positive view of the cadaver sessions, believed them to be useful in their daily practice, and felt that the proposed model was similar to the clinical setting. Trainees believed that these practices improved skills and confidence in performing an RT. CONCLUSIONS: The proposed method of kidney procurement and RT in human cadavers preserved by Thiel's embalming technique is a promising, realistic, and reproducible method of practicing RT surgery.

Valor predictivo de la ecografía uretrovesical transperineal en el diagnóstico de la incontinencia urinaria femenina / The predictive value of transperineal urethrovesical echography in the diagnosis of female urinary incontinence

Introducción: la incontinencia urinaria de exfuerzo (IUE) es una patología femenina frecuente cuya correcta evaluación es importante. .El estudio ultrasonográfico uretrovesical es un método relativamente inexplorado para el diagnóstico y causas de esta entidad. Objetivo: determinar el ángulo pubouretrovesical (PUV), movilidad uretral y distancia pubouretral en reposo y con las maniobras de valsalva y retención en pacientes con incontinencia urinaria de esfuerzo(IUE) y en mujeres sanas Materiales y Métodos: es un trabajo prospectivo longitudinal y analítico, realizado en el servicio de Ginecología del Hospital Essalud III de Puno, se calculó la especificidad, sensibilidad, valor predictivo positivo y valor predictivo negativo. Resultados: el ángulo PUV en pacientes con IUE fue en promedio de: reposo 77º, valsalva 124,6º, retención 67,9º, con una movilidad uretral de 47,6 º, mientras que en mujeres sanas se hallo: reposo 64,5 º, valsalva 78,9 º, retención 60,7 º y movilidad uretral 14,3 º Conclusiones: comparando ambos grupos sólo se alcanzó diferencia estadística altamente significativa en cuanto al ángulo pubouretrovesical en reposo, valsalva y la movilidad uretral. Aplicando al menos 2 de estos 3 criterios se calculó una sensibilidad de 93,3%, especificidad de 90,0%, VPP 90,3% y VPN 93,1% La ecografía perineal es un método útil para el diagnóstico de IUE.

Introducction: the female effort urinay incontinence (EUI) is a feminine frequent pathology whose correct evaluation is important. The study ultrasonographic urethrovesical is a relatively unexplored method for the diagnosis and causes of this entity. Objetives: to determine the pubourethrovesical angle (puv), urethral motility and pubourethral distance while resting and with the Valsalva and retention maneuvers in patients with effort urinary incontinence of (EUI) and healthy women. Material and methods: this is a prospective, longitudinal and analytic study, which undertaken in the gynecology service of the EsSalud III Hospital in Puno. The specificity, sensitivity, positive predictive value and negative predictive value of the technique have been calculated. Results: the puv angle in patients with EUI was on average: while resting 77°, Valsalva maneuver 124.6°, retention 67.9°,with a urethral motility of 47.6°; in healthy women the puv was: while resting 64.5°, Valsalva maneuver 78.9°, retention 60.7° and urethral motility 14.3°. Conclusions: highly significant statistical differences related to the puv angle while resting, Valsalva maneuver and to urethral motility were found between incontinent and healthy women. Applying at least 2 of the 3 criteria sensitivity was 93.3%, specificity 90.0%, vpp 90.3% and vpn 93.1%. Perineal echography is a useful method for the diagnosis of EIU.Introducction: the female effort urinay incontinence (EUI) is a feminine frequent pathology whose correct evaluation is important. The study ultrasonographic urethrovesical is a relatively unexplored method for the diagnosis and causes of this entity.