Estimating the rapid haemodynamic effects of passive leg raising in critically ill patients using bioreactance.

BACKGROUND: Rapid detection of changes in cardiac index (CI) in real time using minimally invasive monitors may be of clinical benefit. We tested whether the Starling-SV bioreactance device, which averages CI over a short 8 s period, could assess the effects of passive leg raising (PLR), a clinical test that is recommended to assess fluid responsiveness during septic shock. METHODS: In 32 critically ill patients, we measured CI by transpulmonary thermodilution (PiCCO2, CItd), pulse contour analysis (PiCCO2, CIPulse), and the Starling-SV device (CIStarling) at baseline. CIPulse and CIStarling were measured again at the end of a PLR test. In the 13 patients with a positive PLR test, CItd, CIPulse, and CIStarling were measured before and after a 500 ml saline infusion. The primary outcome was relative changes from baseline measurements in CItd, CIPulse, and CIStarling. Secondary outcomes compared absolute values measured by each method. RESULTS: Relative changes in CIPulse and CItd were significantly correlated (r=0.82; n=45; P<0.001), with an 89% concordance rate (n=45 paired measurements). Relative changes in CIStarling and CItd were also significantly correlated (r=0.59; n=45; P<0.001) with a 78% concordance rate. For absolute measures of CI (n=77 paired measurements), the bias between CIPulse and CItd was 0.01 L min-1 m-2 (limits of agreement, -0.49 and 0.51 L min-1 m-2; 15% percentage error). Bias between CIStarling and CItd was 0.03 L min-1 m-2 (limits of agreement, -1.61 and 1.67 L min-1 m-2; 48% percentage error). CONCLUSIONS: In critically ill patients, a non-invasive bioreactance device with a shorter averaging period assessed a passive leg raising test with reasonable accuracy.

Colonización bacteriana de las prótesis de pene tras su retirada por fallo mecánico / Bacterial colonization of penile prosthesis after its withdrawal due to mechanical failure

Introducción: La cirugía protésica para el tratamiento de la disfunción eréctil tiene un riesgo de infección de hasta un 3%, pero este riesgo puede aumentar hasta un 18% cuando se trata de una cirugía de recambio. Este aumento del riesgo de infección se atribuye a la colonización bacteriana de las prótesis durante la primera cirugía. Objetivo: Analizar la presencia de gérmenes en las prótesis que se retiran por fallo mecánico (no infección), así como los resultados quirúrgicos y su evolución. Materiales y método: Estudio retrospectivo de todos los recambios realizados entre el año 2013 y el 2016 en un solo centro. Se analizan datos demográficos, tipo de prótesis previa, procedimiento quirúrgico, estudio microbiológico y evolución. Resultados: De 12 procedimientos de recambio se realizó un estudio microbiológico de la prótesis extraída en un total de 10 casos. De los 10 recambios, los cultivos resultaron positivos en 5 casos (50%). Staphylococcus epidermidis fue el germen mayoritario. Todos los pacientes se sometieron a un procedimiento de lavado y se implantó una prótesis recubierta de antibiótico. No registramos infecciones del nuevo dispositivo implantado tras un seguimiento medio de 27,33 meses (DE 4,13; IC 95% 18,22-36,43). Conclusión: En nuestra población a estudio objetivamos un alto índice de colonización bacteriana de las prótesis que se recambian por fallo mecánico. Tras realizar un procedimiento de lavado en el momento del recambio no objetivamos un mayor número de infecciones que lo descrito en casos vírgenes

Introduction: Prosthetic surgery to treat erectile dysfunction has a risk of infection of up to 3%, but this risk can increase to 18% when the surgery involves replacement. This increased risk of infection is attributed to the bacterial colonization of the prosthesis during the initial surgery. Objective: To analyse the presence of germs in the prosthesis that is withdrawn due to mechanical failure (not infection), as well as the surgical results and its progression. Materials and method: A retrospective study was conducted of all replacements performed between 2013 and 2016 at a single centre. We analysed demographic data, prior type of prosthesis, surgical procedure, microbiological study and follow-up. Results: Of the 12 replacement procedures, a microbiological study of the extracted prosthesis was performed in a total of 10 cases. Of the 10 replacements, the cultures were positive in 5 cases (50%). Staphylococcus epidermidis was the most prevalent germ. All patients underwent a flushing procedure, and an antibiotic-coated prosthesis was implanted. We recorded no infections with the new implanted device after a mean follow-up of 27.33 months (SD 4.13; 95% CI 18.22-36.43). Conclusion: In our study population, we observed a high rate of bacterial colonization of the prostheses that were replaced due to mechanical failure. When a flushing procedure was performed during the replacement surgery, there were no more infections than those reported in treatment-naive cases

Bacterial colonization of penile prosthesis after its withdrawal due to mechanical failure. / Colonización bacteriana de las prótesis de pene tras su retirada por fallo mecánico.

INTRODUCTION: Prosthetic surgery to treat erectile dysfunction has a risk of infection of up to 3%, but this risk can increase to 18% when the surgery involves replacement. This increased risk of infection is attributed to the bacterial colonization of the prosthesis during the initial surgery. OBJECTIVE: To analyse the presence of germs in the prosthesis that is withdrawn due to mechanical failure (not infection), as well as the surgical results and its progression. MATERIALS AND METHOD: A retrospective study was conducted of all replacements performed between 2013 and 2016 at a single centre. We analysed demographic data, prior type of prosthesis, surgical procedure, microbiological study and follow-up. RESULTS: Of the 12 replacement procedures, a microbiological study of the extracted prosthesis was performed in a total of 10 cases. Of the 10 replacements, the cultures were positive in 5 cases (50%). Staphylococcus epidermidis was the most prevalent germ. All patients underwent a flushing procedure, and an antibiotic-coated prosthesis was implanted. We recorded no infections with the new implanted device after a mean follow-up of 27.33 months (SD 4.13; 95% CI 18.22-36.43). CONCLUSION: In our study population, we observed a high rate of bacterial colonization of the prostheses that were replaced due to mechanical failure. When a flushing procedure was performed during the replacement surgery, there were no more infections than those reported in treatment-naive cases.

Relación entre los estadios de maduración esqueletal y calcificación dentaria / Relationship between stages of skeletal maturation and tooth calcification

Introducción: El propósito del estudio fue determinar el grado de correlación entre los estadios de calcificación dentaria según Demirjian para caninos, primeras y segundas premolares inferiores, y los estadios de maduración ósea de Fishman (curva de crecimiento puberal). Material y métodos: La muestra consistió en 72 pares de radiografías panorámicas y carpales, 41 de hombres (56,94%) y 31 de mujeres (43,06%), tomadas el mismo día. La muestra se agrupó según sexo y lado a que pertenecía cada diente analizado. Se utilizaron la prueba de correlación de Spearman y tablas de distribución de frecuencia. Resultados: Las correlaciones encontradas fueron significativas en todos los casos; la correlación más alta respecto a Fishman se dio con el canino izquierdo (0,766), y la más baja con el segundo premolar izquierdo (0,581), la más alta correlación en cuanto a calcificación dentaria se dio entre caninos de ambos lados (0,985). El estadio G de calcificación dentaria según Demirjian, coincidió con el pico máximo de crecimiento puberal en mujeres (estadio 6 de Fishman); y en hombres coincidió con la calcificación del sesamoideo (estadio 4 de Fishman). Conclusiones: Se concluye que existe correlación significativa entre los estadios de maduración ósea de Fishman y los estadios de calcificación dentaria

Introduction: The purposeof the study was to determine the degree of correlation between the Demirjian Stages of Calcification of mandibular cuspids, first and second bicuspids and the stages of carpal bone maturation Fishman. Material y methods: The sample calculated at a level of significance of 95% (p<0.05) consisted of double sets of panoramic and wrist radiographs (41 males, 56.94% y 31 females 43.06%) taken the same day. The sample was subdivided according to sex and the side to which each tooth analyzed belonged. Spearman correlation test and tables of frequency distribution were used. Results: The correlation found was of significance in all cases, with the higher Fishman correlation found in the left cuspid (0.766) and the lowest correlation in the right second bicuspid (0.581). The higher correlation due to dental calcification was found between the cupids of both sides (0.985). Demirjian's G calcification stage coincided with the female pubertal growth spurt (stage 6 of Fishman), and males coincided with calcification the sesamoid (stage 4 of Fishman). Conclusion: We conclude that there is a high significance correlation between the stages of calcification of mandibular cuspids, first and second bicuspids and the stages of carpal bone maturation Fishman

[A protocol for the treatment of retinopathy of prematurity in Spain]. / Protocolo de tratamiento de la retinopatía del prematuro en España.

OBJECTIVE: To prepare a protocol for the treatment of retinopathy of prematurity (ROP) agreed by the majority of Spanish ophthalmologists dedicated to this topic. MATERIAL AND METHOD: A draft of the protocol was produced taking into account the experience of the participants and up to date publications. This draft was corrected by all the ophthalmologists participating in the project, and the final document was agreed by all of them. RESULTS: We present general guidelines as an aid for the treatment of ROP, including treatment criteria, treatment methods, a calendar of action, and follow-up. CONCLUSIONS: It is important to have a common working protocol for the treatment of ROP to improve care and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.

Protocolo de tratamiento de la retinopatía del prematuro en España / A protocol for the treatment of retinopathy of prematurity in Spain

Objetivo: Realizar un protocolo de tratamiento de la retinopatía del prematuro (ROP) consensuado por la mayor parte de oftalmólogos españoles dedicados al tema. Material y método: Se realizó un borrador del protocolo según la experiencia de los participantes y las publicaciones actualizadas. Este borrador fue corregido por los participantes en el protocolo y se llegó al documento final consensuado por todos los participantes. Resultados: Se presentan las directrices generales para realizar el tratamiento de la ROP, incluyendo criterios de tratamiento, metodología de actuación, calendario de actuación y seguimiento. Conclusiones: Es importante disponer de un protocolo de actuación común en el tratamiento de la ROP para mejorar la actuación y evitar errores. Aunque cada centro hospitalario deba adaptar el protocolo a su actividad clínica, es recomendable que existan un mínimo de procedimientos consensuados por todos los oftalmólogos dedicados a la ROP (AU)

Objective: To prepare a protocol for the treatment of retinopathy of prematurity (ROP) agreed by the majority of Spanish ophthalmologists dedicated to this topic. Material and method: A draft of the protocol was produced taking into account the experience of the participants and up to date publications. This draft was corrected by all the ophthalmologists participating in the project, and the final document was agreed by all of them. Results: We present general guidelines as an aid for the treatment of ROP, including treatment criteria, treatment methods, a calendar of action, and follow-up. Conclusions: It is important to have a common working protocol for the treatment of ROP to improve care and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain (AU)

Programa de cribado para la retinopatía del prematuro en España / Screening program for retinopathy of prematurity in Spain

Objetivo: Realizar un protocolo de cribado de la retinopatía del prematuro (ROP), consensuado por la mayor parte de oftalmólogos españoles dedicados al tema. Material y método: Se realizó un borrador del protocolo según la experiencia de los participantes y las publicaciones actualizadas. Este borrador fue corregido por los participantes en el protocolo y se llegó al documento final consensuado por todos los participantes. Resultados: Se presentan las directrices generales para realizar el cribado de la ROP, incluyendo criterios de inclusión y exclusión, metodología de exploración y calendario de actuación. Conclusiones: Es importante disponer de un protocolo de actuación común en el cribado de la ROP para mejorar la actuación y evitar errores. Aunque cada centro hospitalario deba adaptar el protocolo a su actividad clínica es recomendable que existan un mínimo de procedimientos consensuados por todos los oftalmólogos dedicados a la ROP (AU)

Objective: To prepare a retinopathy of prematurity (ROP) screening program as agreed by most of Spanish ophthalmologists dedicated to this topic. Material and method: A draft of the protocol was produced taking into account the experience of the participants and current publications. This draft was corrected by all the ophthalmologists participating in the project and the final document produced was agreed by all of them. Results: We present general guidelines to help in the screening of ROP, including treatment criteria, treatment methods, and a calendar of action. Conclusions: It is important to have a common working protocol in the screening of ROP to improve the action and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain (AU)

Screening program for retinopathy of prematurity in Spain.

OBJECTIVE: To prepare a retinopathy of prematurity (ROP) screening program as agreed by most of Spanish ophthalmologists dedicated to this topic. MATERIALS AND METHODS: A draft of the protocol was produced taking into account the experience of the participants and current publications. This draft was corrected by all the ophthalmologists participating in the project and the final document produced was agreed by all of them. RESULTS: We present general guidelines to help in the screening of ROP, including treatment criteria, treatment methods, and a calendar of action. CONCLUSIONS: It is important to have a common working protocol in the screening of ROP to improve the action and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.

Genitoplastía feminizante en pacientes con defectos de la diferenciación sexual: resultados actuales y controversias / Feminising genitoplastic in patients with disorders of sexual differentiation: news results and controversys

Determinar los resultados anatómicos, estéticos y las complicaciones de una técnica quirúrgica estandarizada, a través de un acceso perineal para reconstruir los genitales externos e internos virilizados en pacientes con defectos de la diferenciación sexual (DDS) asociados a una confluencia uretravaginal alta, utilizando la movilización parcial del seno urogenital (SUG). Material y métodos:Diez y seis pacientes con DDS y un SUG significativamente virilizado (Prader IV) fueron tratados a una edad mediana de 1,45 años (rango: 0,4-5,3) con una genitoplastia que incluye: vaginoplastia, labioplastia y clitoroplastia. El SUG movilizado –por debajo de los ligamentos pubouretrales– se utilizó para confeccionar la cara anterior distal de la vagina y el vestíbulo vaginal. Se empleó un colgajo cutáneo perineal para la plástica de la cara posterior distal de la vagina. Seguimiento mediano 7,4 años (rango 2-13). Once pacientes padecían hiperplasia suprarrenal congénita, 4 insensibilidad parcial a los andrógenos y 1, disgenesia gonadal mixta. El seguimiento se realizó cada 4 meses el primer año y anualmente después. En las historias clínicas se registró la opinión de los padres y la de los médicos participantes sobre el aspecto femenino posoperatorio de los genitales. Resultados: En las 16 pacientes el introito vaginal se ubicó en el vestíbulo, por debajo del meato uretral. Dos pacientes sufrieron atrofia del glande. Los padres y médicos participantes coincidieron que la genitoplastia brindó un aspecto estético femenino en todas las pacientes. Se consideraron insatisfactorios los resultados en las dos pacientes con atrofia del glande. Una paciente sufrió incontinencia de orina, tratada con éxito con una inyección endoscópica de una sustancia biomédica y la otra paciente, una estrechez de la plástica vaginal. Conclusiones: Este estudio afirma la eficacia de la técnica descripta para tratar pacientes con DDS que presentan genitales virilizados, con una confluencia vaginal alta. Los autores tienen presente que estos resultados iniciales prometedores deben ser evaluados a largo plazo en la adolescencia.

Combined percutaneous transluminal angioplasty, iliac stent deployment, and femorofemoral bypass for bilateral aortoiliac occlusive disease.

BACKGROUND: We examine the technique of combining percutaneous transluminal angioplasty and secondary intravascular stent deployment with femorofemoral bypass graft in patients with bilateral aortoiliac occlusive disease. STUDY DESIGN: Retrospective review. RESULTS: During the 5-year period from June 1988 to October 1993, 18 patients with iliac occlusion and a hemodynamically significant contralateral iliac stenosis were treated using a combination of endovascular and open surgical techniques. Patients (13 men and 5 women) ranged in age from 50 to 78 years (mean, 64 years). Thirteen patients (72 percent) were treated for claudication, and 5 patients (28 percent) for rest pain or ulceration. Residual intra-arterial pressure gradients following percutaneous transluminal angioplasty or significant postpercutaneous transluminal angioplasty dissection were the indications for stent deployment in 15 and 3 patients, respectively. No operative deaths occurred, but 3 patients (16 percent) had early complications. Primary patency, as determined by life table analysis, was 100 percent, 79 percent, 62 percent, and 51 percent at 1, 2, 3, and 5 years, respectively. Secondary patency at 1, 2, 3, and 5 years was 100 percent, 93 percent, 75 percent, and 63 percent, respectively, with a mean follow-up of 41 months. CONCLUSIONS: The combination of percutaneous transluminal angioplasty with primary or secondary stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis of less than 3 cm in length when the severity of the comorbid illnesses, advanced age, or the presence of prohibitive intra-abdominal pathology makes the avoidance of an abdominal incision desirable.

Stenting for occlusion of the subclavian arteries. Technical aspects and follow-up results.

We report the results of stenting in 17 patients who underwent treatment for total occlusions in the subclavian arteries between July 1991 and December 1995. Fourteen of the lesions were located in the left side; 15 patients had a subclavian steal syndrome. The indications for treatment were vertebrobasilar insufficiency (n = 7); arm claudication (n = 5); vertebrobasilar insufficiency and upper-limb ischemia (n = 3); protection of a left internal mammary artery coronary bypass (n = 1); and an isolated subclavian steal syndrome (n = 1). A total of 23 stents were implanted in 17 patients; in 1 patient, 2 stents migrated during deployment, resulting in a 94% procedural success rate. One case of axillary thrombosis was successfully treated with local thrombolysis and balloon angioplasty. There were no postprocedural neurologic complications or deaths. Follow-up over a mean duration of 19.4 months (range, 4 to 56 months) revealed 1 asymptomatic restenosis at 5 months in a patient with 3 stents. Life-table analysis showed an 81% cumulative patency rate at 6 months. We conclude that stenting for occlusion of the subclavian arteries appears feasible and safe; however, further evaluation in a larger group of patients is needed to confirm these results.

Intraluminal Palmaz stent implantation for treatment of recurrent carotid artery occlusive disease: a plan for the future.

While carotid endarterectomy (CEA) has been used commonly and with great effectiveness for de novo carotid occlusive lesions, its success in cases of recurrent disease has been attenuated by a higher incidence of complications and lower durability. Although interventional techniques have been introduced cautiously into the cerebrovascular system, balloon dilation for both primary and recurrent carotid atherosclerotic disease has been successful in establishing an adequate lumen without an increase in embolic complications over surgery. Because the likelihood exists that postdilation restenosis may be as common in the carotid arteries as it is in other vascular segments, the use of intraluminal stenting may mitigate this long-term complication, a benefit that has been demonstrated in other high flow vessels such as the aorta and iliac arteries. To begin an investigation of this hypothesis, we treated a 69-year-old symptomatic man who required a third intervention for recurrent carotid disease. A > 90% stenosis of the distal third of his right common carotid artery was successfully dilated, and a Palmaz stent was deployed without incident. The patient experienced no complications to the percutaneous procedure, and at 15 months posttreatment, he is well and asymptomatic. Although greater clinical experience must be accumulated with this new approach, intraluminal stenting following balloon dilation for recurrent carotid disease may surpass redo CEA in long-term patency and may entail fewer procedural complications.