[Laparoscopic ureteral reimplantation in the treatment of urinary tract complications after renal transplantation.] / Reimplante ureteral laparoscópico en el tratamiento de las complicaciones urinarias del trasplante renal.

OBJECTIVES: Laparoscopic ureteral reconstructive surgery is routinely performed , because it demonstrated efficacy and safety profiles similar to open surgery in expert hands. The most frequent surgical complications after transplant are urological, appearing in up to 12,5% of the cases; they can compromise graft function and mortality. The most frequent ones include ureterovesical anastomosis stenosis (2,5-7,5%) and vesicoureteral reflux (0,4-2,2), which present in up to 80% of the cases. METHODS: Technical description of the Lich-Gregoire ureteral reimplantation technique in renal transplant patients. RESULTS: From October 2012 we performed 14 Lich-Gregoire laparoscopic ureteral reimplantations in transplant patients, 9 due to distal ureteral stenosis and 5 for vesicoureteral reflux. There were not open conversions. CONCLUSIONS: Laparoscopic surgery has evolved much allowing the performance on techniques that we could not think of years ago. Renal transplant patients present frequent postoperative complications, so they benefit of minimally invasive surgery such as endoscopy or laparoscopy. The Lich-Gregoire laparoscopic reimplantation in transplant patients is reproducible in Centers with experience both in laparoscopic surgery and transplantation.

Reimplante ureteral laparoscópico en el tratamiento de las complicaciones urinarias del trasplante renal / Laparoscopic ureteral reimplantation in the treatment of urinary tract complications after renal transplantation

OBJETIVO: La cirugía reconstructiva ureteral laparoscópica es realizada de forma rutinaria, ya que ha demostrado una eficacia y perfiles de seguridad similares a los de la cirugía abierta en manos expertas. Las complicaciones quirúrgicas más frecuentes tras el trasplante renal son las urológicas, presentándose hasta en el 12,5% de los casos, pudiendo comprometer la función del injerto y la mortalidad. Las más comunes incluyen la estenosis de la anastomosis urétero-vesical (2,5-7,5%) y el reflujo vésico-ureteral (0,4-2,2%), que puede aparecer hasta en un 80% de casos. MÉTODO: Descripción de la técnica de reimplante laparoscópico tipo Lich-Gregoire en pacientes trasplantados renales. RESULTADOS: Desde octubre de 2012 hasta la actualidad hemos realizado 14 reimplantes ureterales laparoscópicos tipo Lich-Gregoire en pacientes trasplantados, 9 por estenosis ureteral distal y 5 por reflujo vésico-ureteral, en ningún caso ha habido necesidad de reconversión a cirugía abierta. CONCLUSIONES: La cirugía laparoscópica ha evolucionado mucho permitiendo realizar técnicas poco imaginables hace años. Los trasplantados renales presentan complicaciones postoperatorias frecuentes, por lo que son ampliamente beneficiados de la cirugía mínimamente invasiva como la endoscopia o laparoscopia. La técnica del reimplante laparoscópico tipo Lich-Gregoire en pacientes trasplantados renales es reproducible en los centros con experiencia laparoscópica y en trasplantes

OBJECTIVES: Laparoscopic ureteral reconstructive surgery is routinely performed , because it demonstrated efficacy and safety profiles similar to open surgery in expert hands. The most frequent surgical complications after transplant are urological, appearing in up to 12,5% of the cases; they can compromise graft function and mortality. The most frequent ones include ureterovesical anastomosis stenosis (2,5-7,5%) and vesicoureteral reflux (0,4-2,2), which present in up to 80% of the cases. METHODS: Technical description of the Lich-Gregoire ureteral reimplantation technique in renal transplant patients. RESULTS: From October 2012 we performed 14 Lich-Gregoire laparoscopic ureteral reimplantations in transplant patients, 9 due to distal ureteral stenosis and 5 for vesicoureteral reflux. There were not open conversions. CONCLUSIONS: Laparoscopic surgery has evolved much allowing the performance on techniques that we could not think of years ago. Renal transplant patients present frequent postoperative complications, so they benefit of minimally invasive surgery such as endoscopy or laparoscopy. The Lich-Gregoire laparoscopic reimplantation in transplant patients is reproducible in Centers with experience both in laparoscopic surgery and transplantation

A home-based treadmill training reduced epicardial and abdominal fat in postmenopausal women with metabolic syndrome.

INTRODUCTION: The current study was designed to determine the effect of home-based treadmill training on epicardial and abdominal adipose tissue in postmenopausal women with metabolic syndrome (MS). A secondary objective was to identify significant correlations between imaging and conventional anthropometric parameters. MATERIAL AND METHODS: Sixty postmenopausal women with MS volunteered for the current trial. Thirty were randomly assigned to perform a supervised home-based 16-week treadmill training program, 3 sessions/week, consisting of a warm-up, 30-40 min treadmill exercise (increasing 5-minutes each 4-weeks) at a work intensity of 60-75% of peak heart rate (increasing 5% each 4-weeks) and cooling-down. Epicardial fat thickness (EFT) was assessed by echocardiography. Abdominal fat mass in the lumbar regions L1-L4 and L4-L5 was determined by dual X-ray absorptiometry. RESULTS: Epicardial fat thickness and abdominal fat percentages were significantly improved after the completion of the training program. Another striking feature of the current study was the moderate correlation that was found between EFT and waist circumference (WC). CONCLUSION: Home-based treadmill training reduced epicardial and abdominal fat in postmenopausal women with MS. A secondary finding was that a moderate correlation was found between EFT and WC. While current investigations are promising, future studies are still required to consolidate this approach in clinical application.

Introducción: El presente estudio se diseñó para conocer la influencia de un programa de entrenamiento aeróbico domiciliario en la masa grasa epicárdica y abdominal de mujeres postmenopausicas con síndrome metabólico (SM). Un segundo objetivo fue identificar correlaciones significativas entre las variables antropométricas ensayadas. Material y Método: Participaron voluntariamente un total de 60 mujeres postmenopausicas con diagnóstico de SM que se distribuyeron aleatoriamente en el grupo de intervención (n=30) o control (n=30). El programa de intervención, desarrollado en el domicilio, consistió en un entrenamiento en tapiz rodante de 16 semanas, 3 sesiones/ semana. La parte principal se realizó a una intensidad del 60-75%FCmax (incrementando 5% cada 4 semanas) durante 30-40 minutos (incrementando 5-minutos cada 4-semanas). La masa grasa epicárdica se determinó mediante ecocardiografía. La masa grasa abdominal de las regiones de interés L1-L4 y L4-L5 se determinó mediante densitometría. Resultados: Se observó un descenso significativo tanto de la masa grasa epicárdica como abdominal tras completar el entrenamiento. Se identificó una correlación moderada entre la masa grasa epicárdica y el perímetro de la cintura de las participantes que podría facilitar su seguimiento clínico. Conclusión: Un programa de entrenamiento de resistencia redujo la masa grasa epicárdica y abdominal. Futuros estudios en esta línea son aún necesarios.

Priapismo de bajo flujo en adolescente como inicio de una leucemia mieloide aguda / Low flow priapism in the adolescent as debut of acute myeloid leukemia

El priapismo se define como una erección prolongada y dolorosa que no tiene por qué ser desencadena por un estímulo sexual y que presenta la característica de no modificarse tras la eyaculación. Se trata de una entidad poco frecuente en edades tempranas y/o adolescentes. En el priapismo de bajo flujo o el venooclusivo o isquémico debe realizarse diagnóstico diferencial con causas hematológicas, neoplasias, cuadros infecciosos, ingesta de fármacos, etc., mientras que para el de alto flujo o arterial o no isquémico debemos centrarnos más en el origen traumático. El tratamiento del priapismo de bajo flujo constituye una urgencia, ya que debemos evitar un daño irreversible, así como un daño psicológico que podría derivarse de las consecuencias de una posible disfunción eréctil. Presentamos un caso de priapismo de bajo flujo en un paciente adolescente como inicio de una leucemia mieloide aguda. En la edad pediátrica y en la adolescencia, como hemos dicho, es poco frecuente, aunque debemos estar alerta, ya que puede ser el comienzo de enfermedades graves (AU)

Priapism is defined as prolonged, painful erection that does not have to be triggered by sexual stimulation. It is characterized by not being modified after ejaculation. This is a rare entity in early and/or adolescent ages. In low flow or ischemic veno-occlusive priapism, differential diagnosis should be made regarding hematologic causes, neoplasms, infectious conditions, drug intake, etc. In high flow or arterial or nonischemic priapism, greater focus should be given to the traumatic origin.Treatment of low flow priapism is an emergency since we must avoid irreversible damage as well as psychological harm that would be derived from the consequences of a possible erectile dysfunction. We report a case of low flow priapism in a teenage patient that was a debut of acute myeloid leukemia. In pediatric and adolescent aged patients, as we have stated, this is uncommon. However, we must be alert to this since it may be the debut of serious diseases (AU)

Medidas antropométricas como predictores del comportamiento lipídico sérico en adolescentes con síndrome de Down / Anthropometrical measurements as predictor of serum lipid profile in adolescents with Down syndrome

Current findings suggest that more attention needs to be given to the increase in body mass being achieved by disabled populations in general and individuals with mental retardation in particular, to minimize long-term negative health consequences. Given that physical activity programs have been reported as one of the most effective ways of improving the health of individuals with Down syndrome, it would be of interest facilitate different tools to contribute to their clinical follow-up. Consequently, this study was designed to assess the correlation between anthropometrical parameters and lipid profile in adolescents with Down syndrome. Anthropometric variables such as body mass index, waist circumference and waist-to-hip ratio as well as serum lipids (total cholesterol, high-density-lipoprotein cholesterol, total-choles-terol/high-density-lipoprotein cholesterol and triglycerides) were measured in 21 male adolescents (16.3 ± 1.1 years) with Down syndrome. Anthropometric parameters presented a positive association with serum lipids except for high-density-lipoprotein cholesterol that was negative. It should be emphasized the strongest association of waist-to-hip ratio to total cholesterol/high-density-lipoprotein cholesterol ratio (r = 0.48; p < 0.05). It is concluded waist circumference and waist-to-hip ratio may be highly recommended in clinical practice as appropriate anthropometric predictors of lipid profile in adolescents with Down syndrome. Further studies are required to assess their behavior during physical activity programs as well as to determine more correlations in these individuals.

Si la obesidad como epidemia está alcanzando cotas preocupantes en la población general, la situación es aún más alarmante entre poblaciones con retraso mental en general y síndrome de Down en particular. Afortunadamente, recientes estudios sugieren que los programas de actividad física parecen una buena estrategia para combatirla, especialmente a edades tempranas. Para facilitar el seguimiento clínico de los mismos, diseñamos este trabajo para determinar las correlaciones más significativas entre parámetros antropométricos (índice masa corporal; índice cintura cadera; perímetro cadera) y el perfil lipídico sérico (colesterol total; colesterol-HDL; ratio colesterol total/HDL; triglicéridos) de 21 jóvenes adolescentes (16.3 ± 1.1) con trisomía 21. El coeficiente de correlación de Pearson demostró que las variables antropométricas ensayadas mostraron una correlación positiva con los distintos parámetros lipidicos excepto para colesterol-HDL que fue negativa. En líneas generales el perímetro de la cintura mostró el mejor comportamiento, mientras el índice cintura cadera mostró la mayor fuerza de asociación con la ratio colesterol-total/colesterol-HDL (r = 0.48; p < 0.05). Futuros estudios en los que se confirme la utilidad de estos hallazgos durante la aplicación de programas de actividad física y en los que se evalúen nuevas asociaciones son necesarios para contribuir a un mejor seguimiento y manejo de estos pacientes.

[Anthropometrical measurements as predictor of serum lipid profile in adolescents with Down syndrome]. / Medidas antropométricas como predictores del comportamiento lipídico sénrico en adolescentes con síndrome de Down.

Current findings suggest that more attention needs to be given to the increase in body mass being achieved by disabled populations in general and individuals with mental retardation in particular, to minimize long-term negative health consequences. Given that physical activity programs have been reported as one of the most effective ways of improving the health of individuals with Down syndrome, it would be of interest facilitate different tools to contribute to their clinical follow-up. Consequently, this study was designed to assess the correlation between anthropometrical parameters and lipid profile in adolescents with Down syndrome. Anthropometric variables such as body mass index, waist circumference and waist-to-hip ratio as well as serum lipids (total cholesterol, high-density-lipoprotein cholesterol, total-cholesterol/high-density-lipoprotein cholesterol and triglycerides) were measured in 21 male adolescents (16.3 +/- 1.1 years) with Down syndrome. Anthropometric parameters presented a positive association with serum lipids except for high-density-lipoprotein cholesterol that was negative. It should be emphasized the strongest association of waist-to-hip ratio to total cholesterol/high-density-lipoprotein cholesterol ratio (r = 0.48; p < 0.05). It is concluded waist circumference and waist-to-hip ratio may be highly recommended in clinical practice as appropriate anthropometric predictors of lipid profile in adolescents with Down syndrome. Further studies are required to assess their behavior during physical activity programs as well as to determine more correlations in these individuals.