RUINAS DE LA IGLESIA DE SAN PEDRO [Material gráfico]

EN LA ACTUALIDAD ESTÁ RESTAURADA. ADQUIRIDA POR EL COLECCIONISTA EN LAS PALMAS G.C.FOTO DE ARCO DE PIEDRA EN PATIO INTERIOR ABANDONADO. RUINAS DE LA IGLESIA DE SAN PEDRO EN TELDE.Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Malignant ureteric obstruction decompression: how much gain for how much pain? A narrative review

Over the last thirty years, the management of Malignant Ureteric Obstruction (MUO) has evolved from a single disciplinary decision to a multi-disciplinary approach. Careful consideration must be given to the risks and benefits of decompression of hydronephrosis for an individual patient. There is a lack of consensus of opinion as well as strong evidence to support the decision process. Outcomes that were identified amongst patients undergoing treatment for MUO included prognosis, quality of life (QOL), complications, morbidity and prognostication tools. A total of 63 papers were included. Median survival was 6.4 months in the 53 papers that stated this outcome. Significant predictors to poor outcomes included low serum albumin, hyponatremia, the number of malignancy related events, and performance status of 2 or worse on the European cooperative cancer group. We propose a multi-centre review of outcomes to enable evidence-based consultations for patients and their families

Ureteroscopy in patients with bleeding diatheses, anticoagulated, and on anti-platelet agents: a systematic review and meta-analysis of the literature

INTRODUCTION: Ureteroscopy (URS) is the most common surgical treatment of urolithiasis and can be problematic in patients with a bleeding diathesis. The intent of this review is to systematically review the literature to assess the safety and efficacy of ureteroscopic procedures in these groups of patients.METHODS: The systematic review was performed according to the Cochrane diagnostic accuracy review guidelines. The search strategy was conducted to perform a comprehensive database search (1990-2017). A cumulative analysis was done and where applicable a comparative analysis between bleeding diathesis patients and those without.RESULTS: Eight studies included were all published between 1998 and 2016 with the total number of participants with bleeding diatheses being 1109 with an age range of 18-97. Overall stone-free rate across the studies was 90.8% vs 86.2% in the control group. There was no significant difference in complications between the bleeding diathesis group and control group (N = 12,757, p = 0.07, 95% confidence interval [CI] 0.92, 6.02, I2 = 78%). Pooled analysis for bleeding-related complications shows a statistically significant difference favoring the control arm (N = 12,757, p ≤ 0.0001, 95% CI 1.81, 5.73, I2 = 0%). Pooled analysis for thrombosis shows no statistically significant difference between the bleeding diathesis group and the control arm (N = 118, p = 0.67, 95% CI 0.23, 9.86, I2 = 48%).CONCLUSION: The use of URS with or without the holmium laser is a safe and efficient modality for treating patients with urolithiasis who also have a bleeding diathesis or are anticoagulated or on antiplatelet agents. However, this review would suggest that the increased risk of procedure related bleeding is not insignificant and a patient-centered approach should be taken with regards to continuing these agents or not correcting bleeding diatheses.</p

Segmental testicular infarction following cysto-prostatectomy

Segmental (partial) testicular infarction is a very rare condition of unknown cause in more than 70% of cases. Several predisposing conditions have been described, but to our knowledge, this is the first documented case and often overlooked complication occurring as a result of cysto-prostatectomy. It usually presents in an acute manner resembling testicular torsion or epididymo-orchitis and is confirmed using ultrasonography. In some cases, it may present insidiously with no pain and may be confused with a testicular tumor due to the hypo-echoic features on imaging. In unclear situations, Doppler sonography shows vascularity and a magnetic resonance scan can be useful to distinguish between the two conditions

Standard versus Tubeless Percutaneous Nephrolithotomy:A Systematic Review

&lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; This article systematically analyses comparative studies to evaluate the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL) versus standard PCNL. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; The Medline, EMBASE, PsycINFO, Cochrane and DARE databases were searched from 1997 to February 2011. Comparative studies evaluating outcomes from standard versus tubeless PCNL were included. Primary outcome measures were post-operative pain scoring, analgesic requirements, duration of hospitalisation/convalescence, operation time, major/minor complications and stone-free rates. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Twenty-four studies were included (11 randomised control trials and 13 retrospective or prospective studies). Levels of pain recorded, analgesic requirements, duration of inpatient stay and convalescence time were all significantly reduced in the tubeless PCNL group. Cost was reduced in two studies. Morbidity was not significantly different between the groups. There was no significant difference between groups regarding stone-free status. &lt;b&gt;&lt;i&gt;Discussion:&lt;/i&gt;&lt;/b&gt; This systematic review has demonstrated that tubeless PCNL is a viable alternative to tubed PCNL in uncomplicated cases. Benefits are as described above. There is no evidence suggesting that patient safety is compromised by the absence of post-operative nephrostomy. The tubeless method has been reported in challenging cases such as stag-horn stones, horseshoe or ectopic kidneys. Promising outcomes have been demonstrated in elderly patients and when clinical needs demand a supracostal approach. Multi-centre randomised controlled trials are needed to fully establish the effectiveness of the tubeless method.</jats:p

Natural history of conservatively managed ureteric stones from a cumulative analysis of 6600 patients

Introduction Ureteric colic has a lifetime prevalence of 10% to 15% and is one of the most common emergency urological presentations. Current EAU recommends conservative management for 'small' (&lt;6mm) ureteral stones if active removal is not indicated. It is important to understand the natural history of ureteric stone disease to help counsel patients with regards to their likelihood of stone passage and anticipated time frame with which they could be safely observed. We aimed to conduct a systematic review to better establish the natural history of stone expulsion. Methodology Literature search was performed using Cochrane and PRISMA guidelines. Outcome measures were patient and stone demographics, expulsion rates, expulsion times, side effect of the medication. A cumulative analysis, with subgroup analysis performed on stone location and size. The results were depicted as percentages and an intention to treat basis was used. Results The literature search identified 70 studies and total of 6642 patients, with a median age of 46 and range of 18-74 years. Overall 64% patients successfully passed their stones spontaneously. About 49% of upper ureteric stones, 58% of mid ureteric stones, and 68% of distal ureteric stones passed spontaneously. Almost 75% of stones &lt;5mm and 62% of stones ≥5mm passed spontaneously. The average time to stone expulsion was about 17 days (range 6-29 days). Nearly 5% of participants required rehospitalisation due to a deterioration of their condition and only about 1% of patients experienced side effects from analgesia provided. Conclusion We believe this current review is the largest study for the evaluation of natural history of ureteric stones. The evidence suggests that ureteric stones will pass without intervention in 64% of patients, however this varies from nearly 50-75% depending on the size and location, in the span of 1-4 weeks.</p