Bilateral laparoscopic synchronous adrenalectomy in bilateral pheochromocytoma: experience in 8 patients

Indexación: Web of Science; ScieloAim: To evaluate 8 cases of bilateral pheochromocytoma and laparoscopic synchronous treatment. Patients and Methods: From May 1999 to May 2010, 8 patients with bilateral pheochromocytoma were found. A complete preoperative workup was done. Results: We perform 8 transperitoneal laparoscopic bilateral synchronous adrenalectomy. There was no open converted procedure. Mean operative time was 184.37 min. (range 95 to 300 min). Mean hospital stay was 3.8 days (range 3 to 5 days). Mean blood loss was 191.25 ml (range 0 to 500 min). In 7 cases the histopathological result was of pheochromocytoma and 1 as a malignant pheochomocytoma based on its histology. Conclusions: With very well establish diagnostic disease, an appropriate anesthetic strategy and as surgical skills, laparoscopic bilateral synchronic adrenalectomy is a feasible and safe surgical technique for bilateral pheochromocytomas.Introducción: La incidencia del feocromocitoma varía entre un 0,005 y un 0,1% y de estos sólo un 10% se presenta en forma bilateral. El objetivo de este trabajo es presentar nuestra experiencia en adrenalectomía laparoscópica bilateral sincrónica en pacientes con diagnóstico de feocromocitoma bilateral. Se revisa la literatura y se analizan nuestros resultados. Material y Métodos: Se realiza una revisión retrospectiva de todos los pacientes sometidos a una adrenelectomía laparoscópica bilateral sincrónica entre mayo de 1999 y mayo de 2010, con diagnóstico de un feocromocitoma bilateral. Todos los pacientes fueron estudiados con medición de catecolaminas plasmáticas y urinarias y estudio por imágenes. Resultados: Se realizaron 8 adrenelectomías laparoscópicas bilaterales sincrónicas. El tiempo promedio de cirugía fue de 184 min (rango 95-300 min). La estadía intrahospitalaria media fue de 3,8 días (rango de 3-5 días). El promedio de sangrado fue de 83 ml (rango 0-500 ml). El diagnóstico histopatológico fue de feocromocitoma en todas las muestras, en un caso se diagnosticó un feocromocitoma maligno. No hubo conversión a cirugía abierta. Conclusiones: La adrene-lectomía laparoscópica bilateral sincrónica para feocromocitomas bilaterales es un procedimiento seguro y de baja morbilidad, realizada por un cirujano con experiencia en cirugía laparoscópica. Es necesario tener previamente el diagnóstico de certeza para el manejo anestésico y postquirúrgico adecuado para estos pacientes.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0718-40262011000600005&nrm=is

Monitoring of the arterial pressure in effort. dominant, not dominant arm or both?

Objetivo: evaluar la diferencia de los valores de Presión arterial (PA) entre ambos brazos, medida simultáneamente, durante una prueba de esfuerzo. Diseño del estudio: estudio transversal. Series de casos. Nivel de evidencia: 3 Material y Métodos: La población se compone de 225 deportistas sanos que realizaron una prueba de esfuerzo en nuestro centro. 128 hombres y 97 mujeres. Edad: 17± 5,5 años. Resultados: La PA tanto sistólica como diastólica no difiere significativamente entre ambos miembros superiores. No obstante, hemos encontrado casos de variabilidad individual donde la PA predomina en un brazo durante el reposo y en el otro brazo durante el máximo esfuerzo. Los valores de TA son independientes del brazo dominante. Conclusiones: La posibilidad que el brazo donde predomina la PA de Reposo no coincida durante el máximo esfuerzo, hace necesario, en nuestra opinión, que se mida la PA en ambos miembros superiores durante la prueba de esfuerzoObjective: To evaluate different blood pressure readings between both arms. Study design: cross-sectional study. Case series. Level of evidence: 3. Methods: a population of 225 healthy athletes underwent stress tests in our center: 128 males and 97 females. Age range: 17 +/- 5.5 years. Results: no significant differences in systolic or diastolic blood pressure readings were found between the right or left arm. We did, however, find cases where blood pressure is higher in one arm while resting and in the other arm during maximal exercise. Blood pressure readings were not associated with the dominant arm. Conclusions: The possibility that the arm in which there is a predominant rest blood pressure does not coincide during maximum stress, makes it necessary, according to our judgment, to measure blood pressure in both upper limbs during stress test

Analysis of the physiological parameters of young spanish badminton players.

El objetivo de nuestro estudio es conocer las características fisiológicas de los jugadores juveniles de bádminton de alto nivel y comparar los parámetros fisiológicos obtenidos en el laboratorio y durante un partido. Se estudiaron 19 jugadores en edad juvenil, 12 varones y 7 mujeres. A todos se les realizó una prueba de esfuerzo máxima en el laboratorio y mediciones antropométricas. Durante la competición se les monitorizó la frecuencia cardiaca, se analizó la concentración de lactato y se valoró su percepción subjetiva al esfuerzo (RPE). El consumo máximo de oxigeno (VO2 máx.) medio se situaba en 56,07 +/- 6,5 ml/Kg/min. El pico de lactato en 3,18 +/- 1,78 mML-1 y la frecuencia cardiaca máxima media (FC máx.) era de 196,75 +/- 5,29 p. p. m., sin diferencias significativas en ninguno de los parámetros estudiados entre varones y hembras en el laboratorio y la competiciónThe aim of our study was to determine the physiological characteristics of young badminton high level players and to compare the physiological parameters obtained in the laboratory and during a match. Nineteen youth players were studied, 12 men and 7 women. A maximal exercise test in the laboratory was performed to the patients and anthropometrics parameters were taken. Their heart rate, lactate concentration and subjective ratings of perceived exertion were tested during competition. The maximum oxygen consumption (VO2 max) has averaged 56.07 + / - 6.5 ml/Kg/min. The peak lactate 3.18 + / - 1.78 MML-1 and the average maximum heart rate (HR max) was 196.75 + / - 5.29 ppm, no significant differences in any of the parameters studied between males and females or between the laboratory and the competitionEl presente trabajo ha sido realizado gracias a una beca de investigación del Centro de Medicina Deportiva de la Comunidad de Madrid (Orden 3025/2010

Cirugía percutánea de la litiasis renal en la era de la litotripsia extracorpórea: Experiencia en 301 pacientes

Indexación: ScieloIntroduction: Percutaneous renal surgery was introduced more than 20 years ago in urological practice. Extracorporeal Shock Wave Lithotripsy (ESWL) enter the urological scene shortly after. Our objective is to show our experience in percutaneous renal surgery after the introduction of the ESWL in our institution. Material and Methods: Surgical outcomes of 301 patients who underwent percutaneous renal surgery as treatment of renal stones were analyzed. This series begins just before the introduction of ESWL in our unit. Results: Renal pelvis was the most frequent localization with 142 cases (47.2%). There were 51 patients with straghorn calculi. 255 (84.7%) were stone free after one single procedure. Residual fragments were managed with many methods, until only 16 patients (5.4%) had residual fragments. Complications occurred in 26 patients (8.9%). There was no mortality. Conclusions: Percutaneous surgery is an important tool in the management of renal stones. In general, renal stones managed with this procedure, are more complex, however the achievement of good results is possible.La cirugía percutánea (CP) de la litiasis renal fue introducida en la urología hace más de 20 años. Poco después lo hizo la litotripsia extracorpórea (LEC). Nuestro objetivo es mostrar la experiencia en CP luego de la introducción de la LEC en nuestro servicio. Material y Métodos: Se analizan en forma retrospectiva los resultados de 301 pacientes operados por CP por litiasis renal. La serie comienza con la adquisición de un litotriptor extracorpóreo en nuestro servicio. Resultados: La localización más frecuente fue la pelvis renal con 142 casos (47,2%). Se observó litiasis coraliforme en 51 pacientes. Doscientos cincuenta y cinco (84,7%), quedaron libres de litiasis con un procedimiento. La litiasis residual fue tratada con diversos métodos, para un total final de 16 pacientes con fragmentos residuales (5,4%). Ocurrieron complicaciones en 26 pacientes (8,9%). No hubo mortalidad. Conclusiones: La cirugía percutánea de la litiasis renal es un procedimiento que debe formar parte importante en la resolución de la litiasis renal. En general las litiasis tratadas son más complejas, sin embargo, los resultados son excelentes.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0718-40262010000500013&nrm=is

Fingolimod reduces hemorrhagic transformation associated with delayed tissue plasminogen activator treatment in a mouse thromboembolic model

BACKGROUND AND PURPOSE: The sphingosine 1-phosphate receptor agonist fingolimod reduces infarct size in rodent models of stroke and enhances blood-brain barrier integrity. Based on these observations, we hypothesized that combination of fingolimod with tissue plasminogen activator (tPA) would reduce the risk of hemorrhagic transformation associated with delayed administration of tPA. METHODS: We evaluated the effects of fingolimod in a mouse model of thromboembolic stroke, in which both the beneficial effect of reperfusion associated with early tPA treatment and hemorrhagic transformation associated with delayed administration mimic clinical observations in humans. RESULTS: Our results demonstrate that fingolimod treatment attenuates the neurological deficit and reduces infarct volume after in situ thromboembolic occlusion of the middle cerebral artery. Combination of fingolimod and tPA improves the neurological outcome of the thrombolytic therapy and reduces the risk of hemorrhagic transformation associated with delayed administration of tPA. CONCLUSIONS: This study confirms the protective efficacy of fingolimod as a treatment against ischemic stroke in another rodent model of stroke (thromboembolic occlusion), and suggests that fingolimod could potentially be used in combination with tPA to reduce the risk of brain hemorrhage

Nefrectomía simple laparoscópica NOTES y LESS con el uso de instrumentos laparoscópicos estándar: Experiencia inicial en 3 casos

Indexación: ScieloIntroduction: Natural orifice transluminal endoscopic surgery (NOTES) and Laparoendoscopic Single Site Surgery (LESS) are emerging technologies, which allows to performed surgical procedures avoiding any surgical scars. However there are some problems due to the lack of equipment available for these procedures. The aim of these study is to present our initial experience with the transvaginal nephrectomy NOTES and LESS using standard laparoscopic instruments. Material and Methods: Two female patients (23 and 26 years old) with diagnosis of recurrent urinary tract infection and renal atrophy. A laparoscopic simple nephrectomy with transvaginal NOTES assistance was performed, using one access port for the camera and two abdominal work ports of 10 and 3mm. In a third patient (15 years old) a transumbilical LESS nephrectomy was preformed with the use of standard laparoscopic instruments. Results: Average operative time was 110 min (40-200), with an estimated blood loss of 200 cc. There were no perioperative complications and all patients were discharged 36 hours after surgery. Conclusion: Laparoscopic simple nephrectomy with transvaginal NOTES assistance and LESS are technically feasible with the use of standard laparoscopic instruments. Special access trocars and instruments development for this procedure will allow to performed a pure technique without the use of abdominal incisions.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0718-40262010000300016&nrm=is

Participation of family in the intervention of occupational therapy: Parents experiences of children with cerebral palsy in Valdivia city

This research aims to analyze the experiences of parents about the therapeutic process of their children with cerebral palsy. To make this possible, it is relevant to provide a contextual perspective of this pathology, granting protagonism to the experiences of participation in parents of children with this condition, as well as know the occupational implications that this mentioned participation carries. A qualitative methodology was used, with a narrative design. Main results expose that the participation of parents is essential in the process of functional recovery of their children, nevertheless this carries occupational repercussions at emotional, social and physical levels. The research concludes that parents perceive their participation as satisfactory, nevertheless this one changes according to the context where it is realized and the severity of the clinical profile of the kid. In the same manner, an occupational imbalance is distinguished in the area of leisure and free time, associated with the distribution of the time and work - care of the ki

Transmutations and spectral parameter power series in eigenvalue problems

We give an overview of recent developments in Sturm-Liouville theory concerning operators of transmutation (transformation) and spectral parameter power series (SPPS). The possibility to write down the dispersion (characteristic) equations corresponding to a variety of spectral problems related to Sturm-Liouville equations in an analytic form is an attractive feature of the SPPS method. It is based on a computation of certain systems of recursive integrals. Considered as families of functions these systems are complete in the $L_{2}$-space and result to be the images of the nonnegative integer powers of the independent variable under the action of a corresponding transmutation operator. This recently revealed property of the Delsarte transmutations opens the way to apply the transmutation operator even when its integral kernel is unknown and gives the possibility to obtain further interesting properties concerning the Darboux transformed Schr\"{o}dinger operators. We introduce the systems of recursive integrals and the SPPS approach, explain some of its applications to spectral problems with numerical illustrations, give the definition and basic properties of transmutation operators, introduce a parametrized family of transmutation operators, study their mapping properties and construct the transmutation operators for Darboux transformed Schr\"{o}dinger operators.Comment: 30 pages, 4 figures. arXiv admin note: text overlap with arXiv:1111.444

Wavelet transform selection method for biological signal treatment

This paper presents the development and evaluation of an algorithm for compressing fetal electrocardiographic signals, taken superficially on the mother’s abdomen. This method for acquiring ECG signals produces a great volumen of information that makes it difficult for the records to be stored and transmitted. The proposed algorithm aims for lossless compression of the signal by applying Wavelet Packet Transform to keep errors below the unit, with compression rates over 20:1 and with conserved energy in reconstruction as comparison parameter. For algorithm validation, the signal files provided by PhysioBank DataBase are used