EELS: Autonomous snake-like robot with task and motion planning capabilities for ice world exploration.

Ice worlds are at the forefront of astrobiological interest because of the evidence of subsurface oceans. Enceladus in particular is unique among the icy moons because there are known vent systems that are likely connected to a subsurface ocean, through which the ocean water is ejected to space. An existing study has shown that sending small robots into the vents and directly sampling the ocean water is likely possible. To enable such a mission, NASA's Jet Propulsion Laboratory is developing a snake-like robot called Exobiology Extant Life Surveyor (EELS) that can navigate Enceladus' extreme surface and descend an erupting vent to capture unaltered liquid samples and potentially reach the ocean. However, navigating to and through Enceladus' environment is challenging: Because of the limitations of existing orbital reconnaissance, there is substantial uncertainty with respect to its geometry and the physical properties of the surface/vents; communication is limited, which requires highly autonomous robots to execute the mission with limited human supervision. Here, we provide an overview of the EELS project and its development effort to create a risk-aware autonomous robot to navigate these extreme ice terrains/environments. We describe the robot's architecture and the technical challenges to navigate and sense the icy environment safely and effectively. We focus on the challenges related to surface mobility, task and motion planning under uncertainty, and risk quantification. We provide initial results on mobility and risk-aware task and motion planning from field tests and simulated scenarios.

Cistectomía radical asistida por robot vs. cistectomía radical abierta: revisión sistemática de ensayos controlados aleatorizados / Robot-assisted vs. open radical cystectomy: Systematic review and meta-analysis of randomized controlled trials

Introducción En la última década se han puesto en marcha varios ensayos controlados aleatorizados (ECA) con el objetivo de evaluar la seguridad quirúrgica y la eficacia oncológica de la cistectomía radical asistida por robot (CRAR) frente a la cistectomía radical abierta (CRA) en pacientes con cáncer de vejiga. El objetivo del estudio fue realizar una revisión sistemática y un metaanálisis de ECA para comparar los resultados perioperatorios y oncológicos de ambas. Métodos Se realizó una búsqueda bibliográfica hasta julio de 2022 en las bases de datos PubMed/Medline, Embase y Web of Science. Se siguieron las directrices de la declaración PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) para identificar los estudios elegibles. Los criterios de evaluación fueron los resultados intraoperatorios, postoperatorios y oncológicos de la CRAR frente a la CRA. Resultados Un total de 8ECA con 1.024 pacientes cumplieron los criterios de inclusión. La CRAR se asoció con un tiempo quirúrgico mayor (media de 92,34 min, IC 95%: 83,83-100,84; p<0,001) y una tasa de transfusión de sangre menor (odds ratio [OR] 0,43; IC 95%: 0,30-0,61; p<0,001). No se observaron diferencias en cuanto a las complicaciones globales (p=0,28) ni graves (p=0,57) a los 90 días, la duración de la estancia hospitalaria (p=0,18), la recuperación de la función intestinal (p=0,67), la calidad de vida relacionada con la salud (p=0,86), la recurrencia (p=0,77) ni la progresión (p=0,49) de la enfermedad entre los 2abordajes. La principal limitación reside en el bajo número de pacientes incluidos en el 50% de los ECA revisados. Conclusiones Este estudio respalda la no inferioridad de la CRAR respecto a la CRA en términos de seguridad quirúrgica y resultados oncológicos. El beneficio de tasas reducidas de transfusión sanguínea obtenido con la CRAR debe sopesarse con relación a los costes derivados del procedimiento (AU)

Introduction Several randomized controlled trials (RCTs) have been launched in the last decade to examine the surgical safety and oncological efficacy of robot-assisted (RARC) vs. open radical cystectomy (ORC) for patients with bladder cancer. The aim of the study was to perform a systematic review and meta-analysis of RCTs to compare the perioperative and oncological outcomes of RARC vs. ORC. Methods A literature search was conducted through July 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The outcomes were intraoperative, postoperative, and oncological outcomes of RARC vs. ORC. Results A total of 8RCTs comprising 1,024 patients met our inclusion criteria. RARC was associated with longer operative time (mean 92.34min, 95% CI: 83.83-100.84, P<0.001) and lower blood transfusion rate (Odds ratio [OR] 0.43, 95% CI: 0.30-0.61, P<0.001). No differences emerged in terms of 90-day overall (P=0.28) and major (P=0.57) complications, length of stay (P=0.18), bowel recovery (P=0.67), health-related quality of life (P=0.86), disease recurrence (P=0.77) and progression (P=0.49) between the 2approaches. The main limitation is represented by the low number of patients included in half of RCTs included. Conclusions This study supports that RARC is not inferior to ORC in terms of surgical safety and oncological outcomes. The benefit of RARC in terms of lower blood transfusion rate need to be balanced with the cost related to the procedure (AU)

Robot-assisted vs. open radical cystectomy: systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Several randomized controlled trials (RCTs) have been launched in the last decade to examine the surgical safety and oncological efficacy of robot-assisted (RARC) vs open radical cystectomy (ORC) for patients with bladder cancer. The aim of the study was to perform a systematic review and meta-analysis of RCTs to compare the perioperative and oncological outcomes of RARC vs ORC. METHODS: A literature search was conducted through July 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The outcomes were intraoperative, postoperative, and oncological outcomes of RARC vs ORC. RESULTS: A total of eight RCTs comprising 1,024 patients met our inclusion criteria. RARC was associated with longer operative time (mean 92.34min, 95% CI 83.83-100.84, p<0.001) and lower blood transfusion rate (Odds ratio [OR] 0.43, 95% CI 0.30-0.61, p<0.001). No differences emerged in terms of 90-day overall (p=0.28) and major (p=0.57) complications, length of stay (p=0.18), bowel recovery (p=0.67), health-related quality of life (p=0.86), disease recurrence (p=0.77) and progression (p=0.49) between the two approaches. The main limitation is represented by the low number of patients included in half of RCTs included. CONCLUSIONS: This study supports that RARC is not inferior to ORC in terms of surgical safety and oncological outcomes. The benefit of RARC in terms of lower blood transfusion rate need to be balanced with the cost related to the procedure.

Thermovaccination: Thermoheliox as an Immune Response Stimulant. Kinetics of Antibodies and C-Reactive Protein Synthesis in Coronaviral Infection.

The high efficiency of using thermoheliox (inhalation with a high-temperature mixture of helium and oxygen) in the treatment of patients affected by COVID-19 was shown. The dynamics of accumulation of IgG, IgM, and C-reactive protein (CRP) in patients with coronavirus infection in the "working" and control groups was studied experimentally. It was shown that thermoheliox intensifies the synthesis of IgG, IgM, and CRP antibodies, while eliminating the induction period on the kinetic curves of the synthesis of specific antibodies in the IgG form and transfers the synthesis of CRP to a fast phase. The results of experiments confirm the previously obtained data based on the analysis of the kinetic model of the development of coronaviral infection in the human body.

Tumorectomía off-clamp por retroperitoneocopia en tumores renales posteriores de complejidad media (Padua score 8-9) / Off-Clamp Renal Tumourectomy by Retroperitoneoscopy in Posterior Renal Tumours of Medium Complexity (Padua score 8-9)

Introducción: Las guías recomiendan cirugía parcial en tumores renales T1. Diferentes aspectos han evolucionado en estos últimos años: forma y duración del clampaje, enucleación, abordaje por retroperitoneoscopia y la utilización de puertos de 3 mm. Presentamos nuestra serie inicial de tumorectomía renal laparoscópica por retroperitoneoscopia (TRLR) analizando nuestra curva de aprendizaje y el uso de instrumental de 3 mm. Material y métodos: De enero 2011 a enero 2015, realizamos TRLR a 50 pacientes con tumores renales T1 de cara posterior o convexidad renal. Tras 10 casos, la técnica pasó a ser off-clamp y posteriormente en 11 casos se realizó con 3 mm. Resultados: El tamaño tumoral fue de 34,36 mm (14-62) con un PADUA de 8,42 (5-12), tiempo operatorio de 163,1 minutos (75-300) y tiempo de isquemia caliente de 4,21 minutos (0-28). No se clampó la arteria renal principal en 41 (82%) pacientes y ningún vaso (isquemia 0) en 39 (78%). Siete casos presentaron márgenes positivos (6 focales). Se realizaron 11 TRLR con material de 3 mm con un tiempo quirúrgico, sangrado intraoperatorio y estancia hospitalaria menores. Conclusiones: La retroperitoneoscopia sumada a enucleación permiten la extirpación sin clampaje de tumores posteriores del riñón con una curva de aprendizaje relativamente corta. El material de 3 mm permite realizar la técnica aunque en nuestra experiencia ha resultado en una mayor tasa de márgenes quirúrgicos positivos

Background: The guidelines recommend partial surgery for T1 renal tumours. Various aspects of this surgery have evolved in recent years, including the clamping method and duration, enucleation, the retroperitoneoscopic approach and the use of 3 mm ports. We present our initial series on laparoscopic renal tumourectomy by retroperitoneoscopy (LRTR) and analyse our learning curve and use of 3-mm instrumentation. Material and Methods: From January 2011 to January 2015, we performed LRTR on 50 patients with posterior or convex T1 renal tumours. After 10 cases, the technique changed to off-clamp, and 11 cases were subsequently performed with 3 mm instrumentation. Results: The mean tumour size was 34.36 mm (14-62), with a mean PADUA score of 8.42 (5-12). The mean operative time was 163.1 minutes (75-300), and the mean warm ischaemia time was 4.21 minutes (0-28). The main renal artery was not clamped in 41 (82%) patients, and no vessel (zero ischaemia) was clamped in 39 (78%) patients. Seven cases had positive margins (6 focal). Eleven LRTRs were performed with 3 mm instrumentation, with shorter surgical times, less intraoperative bleeding and shorter hospital stays. Conclusions: Retroperitoneoscopy coupled with enucleation enables the extirpation without clamping of posterior renal tumours, with a relatively short learning curve. The 3-mm material enables the technique to be performed, although in our experience it has resulted in a higher rate of positive surgical margins

Off-Clamp Renal Tumourectomy by Retroperitoneoscopy in Posterior Renal Tumours of Medium Complexity (Padua score 8-9).

BACKGROUND: The guidelines recommend partial surgery for T1 renal tumours. Various aspects of this surgery have evolved in recent years, including the clamping method and duration, enucleation, the retroperitoneoscopic approach and the use of 3mm ports. We present our initial series on laparoscopic renal tumourectomy by retroperitoneoscopy (LRTR) and analyse our learning curve and use of 3-mm instrumentation. MATERIAL AND METHODS: From January 2011 to January 2015, we performed LRTR on 50 patients with posterior or convex T1 renal tumours. After 10 cases, the technique changed to off-clamp, and 11 cases were subsequently performed with 3mm instrumentation. RESULTS: The mean tumour size was 34.36 mm (14-62), with a mean PADUA score of 8.42 (5-12). The mean operative time was 163.1 minutes (75-300), and the mean warm ischaemia time was 4.21 minutes (0-28). The main renal artery was not clamped in 41 (82%) patients, and no vessel (zero ischaemia) was clamped in 39 (78%) patients. Seven cases had positive margins (6 focal). Eleven LRTRs were performed with 3mm instrumentation, with shorter surgical times, less intraoperative bleeding and shorter hospital stays. CONCLUSIONS: Retroperitoneoscopy coupled with enucleation enables the extirpation without clamping of posterior renal tumours, with a relatively short learning curve. The 3-mm material enables the technique to be performed, although in our experience it has resulted in a higher rate of positive surgical margins.

Implicaciones del déficit de vitamina D en el paciente litiásico y en la población general / Implications of vitamin D deficiency in lithiasic patient and in general population

Contexto y objetivo: El déficit de vitamina D ocasiona problemas en el metabolismo fosfocálcico, pero también de salud general. El objetivo es realizar una revisión del tema, y para contextualizarlo en el paciente litiásico realizar un estudio sobre el déficit de vitamina D y su posible relación con la alteración de los valores de PTH. Adquisición de evidencias: Revisión del metabolismo, la epidemiología y la relación del déficit de vitamina D con varias enfermedades. Análisis multivariable y estudio de correlación entre los niveles de vitamina D y PTH en 100 pacientes litiásicos. Síntesis de evidencias: Se presenta una revisión sobre el metabolismo, receptores, funciones y valoración de la vitamina D, así como del tratamiento de su déficit. Se ha encontrado un déficit de vitamina D superior en el paciente litiásico que en la población general y que se relaciona significativamente con un incremento de los valores de PTH. Además hay suficiente literatura que muestra una relación del déficit de vitamina D no solo con enfermedad ósea, sino con múltiples enfermedades. Conclusión: En todo paciente litiásico debe descartarse y tratarse un posible déficit de vitamina D

Context and objective: Vitamin D deficiency causes problems in mineral metabolism but also overall health. In first place a review of the topic was carried out. Then, in order to contextualize it in lithiasic patient, a study on Vitamin D deficiency and its possible relationship with impaired PTH levels is performed. Evidences acquisition: A review of topics such as metabolism, epidemiology and the relationship of vitamin D deficiency with several pathologies was performed. Besides a multivariate analysis and a correlation study between vitamin D and PTH levels was conducted in 100 lithiasic patients. Evidences synthesis: We present a review of Vitamin D metabolism, receptors and functions, as well as about its valuation methodology and the treatment of its deficiency. Lithiasic patients show a higher vitamin D deficiency than general population. Vitamin D deficiency has been significantly associated with increased PTH levels. In addition, there is enough literature showing a relationship between vitamin D deficiency not only with bone disease, but also with multiple diseases. Conclusion: vitamin D levels should be measured in all lithiasic patients, and those with vitamin D deficiency should be treated

Cáncer de próstata: ventajas e inconvenientes del cribado diagnóstico / Prostate cancer: Advantages and disadvantages of diagnostic screening

El cáncer de próstata (CaP) es la segunda neoplasia mas diagnosticada. En España corresponde a la tercera causa de cáncer en hombres (excluyendo los tumores de piel no melanoma). Aun así, la evidencia actual ha llevado a organismos internacionales a contraindicar su cribado por el poco beneficio que se puede generar en cuanto a mortalidad sopesando los riesgos que conlleva el diagnóstico y el tratamiento. El objetivo de este trabajo es una revisión bibliográfica sobre las potenciales ventajas e inconvenientes del cribado con PSA a partir del consenso basado en la evidencia científica publicada en la literatura. Para ello se realiza una revisión de la literatura examinando las recomendaciones del cribado con PSA de los diferentes organismos urológicos americano y europeo, evaluando los ensayos clínicos aleatorizados y no aleatorizados en los que se basan sus recomendaciones. Se examinaron los posibles beneficios en cuando a mortalidad, los riesgos y prejuicios condicionados al cribado y el tratamiento del cáncer de próstata. Estipulamos nuestra recomendación basada en la evidencia actual (AU)

Prostate cancer is the second most frequently diagnosed cancer. In Spain only is the third leading cause of cancer deaths, yet evidence has addressed some international associations to stand against PSA screening declaring that screening´s harms outweigh the benefits of such procedure. The objetive of this paper is searched the literature about potential benefits and harms that PSA screening can generate. We also stipulated a consensus based on the scientiphic evidence. We reviewed guideline publications from the European and American urological institutions about PSA screening recommendations. We examined both, randomized controlled and non-randomized trials in which its recommendations are based. We reviewed the possible advantages and benefits related to PSA screening and prostate cancer treatment stipulating our consensus based on the evidence (AU)

Implications of vitamin D deficiency in lithiasic patient and in general population.

CONTEXT AND OBJECTIVE: Vitamin D deficiency causes problems in mineral metabolism but also overall health. In first place a review of the topic was carried out. Then, in order to contextualize it in lithiasic patient, a study on Vitamin D deficiency and its possible relationship with impaired PTH levels is performed. EVIDENCES ACQUISITION: A review of topics such as metabolism, epidemiology and the relationship of vitamin D deficiency with several pathologies was performed. Besides a multivariate analysis and a correlation study between vitamin D and PTH levels was conducted in 100 lithiasic patients. EVIDENCES SYNTHESIS: We present a review of Vitamin D metabolism, receptors and functions, as well as about its valuation methodology and the treatment of its deficiency. Lithiasic patients show a higher vitamin D deficiency than general population. Vitamin D deficiency has been significantly associated with increased PTH levels. In addition, there is enough literature showing a relationship between vitamin D deficiency not only with bone disease, but also with multiple diseases. CONCLUSION: vitamin D levels should be measured in all lithiasic patients, and those with vitamin D deficiency should be treated.

Litiasis úrica coraliforme bilateral de origen intestinal. Presentación de un caso tratado con la combinación quirúrgica NLP/RIRS/ECIRS / Uric bilateral staghorn lithiasis of intestinal origin. Report of a case treated with surgical combination NLP / RIRS / ECIRS

La cirugía endoscópica renal (por vía percutánea o por vía retrograda) se ha consolidado como una técnica de elección para los cálculos renales. En los más voluminosos (mayores de 2-3 cm de diámetro mayor) está indicada la nefrolitotomía percutánea (NLP) y en los menores la cirugía retrógrada intrarrenal RIRS (exceptuando los tratables con litotricia extracorpórea por ondas de choque). La ECIRS es una modalidad mixta. La litotricia endoscópica con láser es un tratamiento eficaz en las tres técnicas. En NLP es necesario usar altas energías La litiasis de AU representan un 10% del total de cálculos en España. Entre los factores etiológicosfiguran la dieta, los procesos inductores de lisis celular (ciertas neoplasias, quimioterapia) y algunos trastornos digestivos. Aunque la bilateralidad es muy frecuente es más raro encontrar coraliformes bilaterales. Presentamos un caso de litiasis renal úrica bilateral coraliforme (AU)

Renal endoscopic surgery (percutaneously or via retrograde) has become a technique of choice for kidney stones. In the more bulky (greater than 2-3 cm in diameter) is indicated percutaneous nephrolithotomy (PCNL). In smaller is indicated intrarenal retrograde surgery (RIRS), excluding those that can be treated with extracorporeal shock wave lithotripsy. The ECIRS is a mixed mode. Endoscopic laser lithotripsy is an effective treatment in the three techniques. In NLP is necessary to use high energy. The uric acid stones account for 10% of all stones in Spain. Etiologic factors include diet, conditions inducing cell lysis (certain malignancies, chemotherapy) and some digestive disorders. Although it is very frequent bilaterality is rare to find bilateral staghorn. We report a case of bilateral staghorn uric kidney stones secondary to intestinal disorder treated with a combination of three pocedures (AU)

Autotrasplante renal en aneurisma complejo de arteria renal derecha / Renal autotransplantation in complex right renal artery aneurysm

Se presenta un caso clínico de aneurisma de la arteria renal derecha resuelto con cirugía extracorpórea de banco y autotrasplante a fosa ilíaca. Los aneurismas de la arteria renal pueden ser: saculares, fusiformes y disecantes, pudiendo interesar las arterias segmentarias. La HTA, dolor lumbar y la hematuria son manifestaciones clínicas clásicas. La angio TC es la técnica diagnóstica de elección. El tratamiento quirúrgico está indicado en lesiones mayores de 3 cm, evaluando en cada caso particular el riesgo-beneficio de la intervención. La angioplastia es la técnica quirúrgica de elección cuando no existe posibilidad de tratamiento endovascular. Cuando la lesión arterial es compleja una opción es realizar el autotrasplante renal (AU)

A case of aneurysm of the right renal artery treated with reovascular surgery (autotransplantation) is presented. The renal artery aneurysm can be: saccular, fusiform and dissecting, and may be interested in the segmental arteries. Hypertension, lumbar pain and hematuria are classic clinical manifestations. The angio CT is the diagnostic procedure of choice. Surgical treatment is indicated for lesions larger than 3 cm, evaluating the risk-benefit of the intervention. Angioplasty is the surgical technique of choice when endovascular treatment is no feasible. When arterial injury is complex option is to perform a renal autotransplantation (AU)

Disinergia vesicoesfinteriana lisa. Aportación de un caso clínico y comentarios / Bladder dysinergia. Report of a clinical case and comments

Se presenta un caso en un varón de 40 años con antecedente de colon irritable, que presenta síntomas de vaciado con clínica, con obstrucción infravesical severa en ausencia de compresión prostática, estenosis de uretra y de alteración esfinteriana durante la micción. En las exploraciones se observa un cuello vesical cerrado durante la fase del vaciado, a toda esta clínica se la denomina disinergia lisa o del esfínter liso (obstrucción infravesical funcional). Dentro de las pruebas diagnósticas se resalta el papel del estudio vídeo-urodinámico. La finalidad fundamental en el tratamiento de la disinergia lisa es mejorar el vaciado mediante tratamientos desobstructivos (fármacos y/o quirúrgicos). La videourodinamia ofrece una completa información funcional y anatómica, a tener en cuenta en pacientes jóvenes con obstrucción infravesical (AU)

Male of 40 years with a history of irritable colon, presenting with clinical voiding symptoms, with severe bladder outlet obstruction in the absence of compression prostate, urethral stenosis and sphincter disruption during urination. Bladder neck closed during the emptying phase is observed in the scans, all this clinic is called internal sphincter or smooth dyssynergia (functional bladder neck outlet obstruction). Among the diagnostic tests the role of videourodynamic study is highlighted. The primary purpose in treating this condition is improve obstruction by desobstructive therapies (drugs or surgical). The videourodynamics offers a complete functional and anatomical information to be considered in young patients with bladder outlet obstruction (AU)

Manejo conservador de los tumores del tracto urinario superior. Revisión / Conservative management of upper urinary tract tumors. A review

El tratamiento convencional para los tumores del tracto urinario superior (TTUS) es la nefroureterectomía. En algunos casos (tumores de pequeño tamaño, no invasivos y de bajo grado) se aceptan las opciones quirúrgicas conservadoras, como la ureteroscopia (URS) y la cirugía percutánea. La URS flexible ha permitido el acceso a todos los tumores más inaccesibles. La ablación con láser es una de sus ventajas. Como tratamiento adyuvante existe la inmunoterapia o la quimioterapia, aplicadas por instilación local con buenos resultados. En este trabajo se revisan las opciones de tratamiento conservador de los TTUS y las modalidades de seguimiento (AU)

Conventional treatment for upper urinary tract tumors (UUTT) is nephroureterectomy. In some cases (small tumors, non-invasive and low grade) are accepted conservative surgical options such as ureteroscopy (URS) and percutaneous surgery. Flexible URS has allowed access to all inaccessible tumors. Laser ablation is one of its advantages. As adjuvant therapy exists immunotherapy or chemotherapy for local instillation with good results. In this paper we review the options (UUTT) of conservative treatment and monitoring procedures (AU)

Lesión en el colon como complicación de la nefrolitotomía percutánea / Injury to the colon as a complication of percutaneous nephrolithotomy

La cirugía percutánea es una opción quirúrgica efectiva y segura para el tratamiento de cálculos renales, tumores del sistema colector y para realizar endopielotomía anterógrada por síndrome de la unión pieloureteral. La lesión colónica yatrogénica es poco frecuente, pero puede tener consecuencias graves. El diagnóstico de la misma es habitualmente difícil, y las estrategias de tratamiento son controvertidas. Se presenta un caso de lesión de colon descendente durante una nefrolitotomía percutánea tratado con éxito aplicando medidas conservadoras (AU)

Percutaneous endoscopic renal surgery is usually a safe and effective treatment for patients with complex renal calculi, tumors of the collecting system, and ureteropelvic junction obstruction. A unique set of complications, however, can occur with this surgical approach that may involve the targeted kidney and surrounding structures. Iatrogenic colon injury is an uncommon but serious complication. Diagnosis is sometimes delayed, and treatment strategies are still controversial. We report a case of descending colon injury during percutaneous nefrolithotomy successfully treated using conservative measures (AU)

[Computed tomographic semiotics of respiratory tuberculosis in HIV-infected patients].

OBJECTIVE: to study the computed tomographic (CT) semiotics of respiratory tuberculosis in HIV-infected patients in relation to the degree of immunosuppression. SUBJECT AND METHODS: The study enrolled 74 patients with verified respiratory tuberculosis in the presence of HIV infection. According to the degree of immunosuppression and the Centers for Disease Control (CDC) and Prevention classification (Atlanta, USA, 1993), the patients were divided into 3 groups: (1) CD4 > or = 500 cells/microl (n = 10); 2) CD4 200-499 cells/microl (n = 28); (3) CD4 <200 cells/microl (n = 36). RESULTS: With spiral CT, focal changes with a predominance of clear-cut foci are visualized at a high frequency in the patients with pulmonary tuberculosis in the presence of HIV infection. In progressive immunosuppression, the CT pattern displays atypical syndromes (frosted glass-type foci, interstitial infiltration, and thin-walled cavities) with the lower rate of alveolar infiltration with confluent foci, as well as lung tissue decay. Enlarged intrathoracic lymph nodes are characteristic of 70.0% of the patients with HIV infection and tuberculosis regardless of the level of CD4 cells. CONCLUSION: As immunosuppression progresses, the CT pattern of respiratory tuberculosis in the presence of HIV infection shows as atypical syndromes (unclearly defined frosted glass-type focal changes, interstitial infiltrations, and thin-walled cavernous masses). A marked polymorphism in changes and a high rate of lymph node involvement are characteristic.

Fistula uretrorectal post prostatectomia radical: reparación vía perineal con interposición del músculo gracilis. Caso clinico / Post radical prostatectomy fistula: perineal repair with gracilis muscle interposition. Clinical case

Existen diversas técnicas quirúrgicas para la solución de las fístulas uretrorectales debidasa cirugía prostática. La plastia con interposición de músculo gracilis vía perineal es una técnica eficaz. Se presenta un caso clínico de fístula uretrorectal post prostatectomía radical y su resolución por vía perineal con músculo gracilis (AU)

There are several surgical techniques for the solution of uretrorectales fistulas due to prostate surgery. Plasty with gracilis muscle interposition perineal approach is an effective technique. We report a case of fistula uretrorectal post radical prostatectomy and perineal resolution with gracilis muscle (AU)