Evaluación urodinámica y comparativa de la calidad de vida en pacientes con trastorno de vaciamiento vesical sometidos a terapia InterStim, Medtronic®

ResumenAntecedentesDesde 1980 la terapia de neuroestimulación sacra ha demostrado ser una terapia válida y alternativa en el manejo de los trastornos miccionales por patología del tracto urinario bajo, siendo sus principales indicaciones la retención urinaria idiopática, la incontinencia de urgencia y la incontinencia fecal. En nuestro país sigue siendo una terapia novedosa y no se cuenta aún con estudios que evalúen esta eficacia en términos de calidad de vida o con parámetros cuantitativos.Objetivo del estudioEstablecer la eficacia de la terapia de neuroestimulación sacra tipo InterStim, Medtronic®, en el manejo de los pacientes con trastornos de vaciamiento vesical, efectuando un análisis urodinámico y de la calidad de vida comparativo previo y posterior al tratamiento, determinando los volúmenes miccionales, los períodos de incontinencia, la satisfacción del paciente y la calidad de vida.Material y métodosDesde enero de 2010 hasta junio de 2013, en el Hospital Central Militar se realizó evaluación urodinámica y comparativa de la calidad de vida mediante el empleo del instrumento SF-36 v2 (versión mexicana) e ICIQSF, en los pacientes que presentaron trastorno de vaciamiento vesical de etiología no obstructiva y que fueron refractarios a tratamiento médico.ResultadosSe incluyeron 10 pacientes en el estudio, bajo los siguientes diagnósticos: disinergia detrusor-esfínter, vejiga hiperactiva y retención urinaria no obstructiva, ubicados por género (2 masculinos y 8 femeninos). En la totalidad de los pacientes se presentó mejoría del 50% o superior durante la fase de prueba de la terapia de neuroestimulación, y se colocó fase definitiva con los siguientes resultados: se obtuvieron resultados equivalentes al 50-65% de mejoría en los parámetros cualitativos de función física, función social y rol emocional, así como en las variables cuantitativas de volumen de vaciamiento, eficacia de vaciamiento y disminución de los períodos de incontinencia.DiscusiónComo se ha establecido a nivel de la literatura mundial, nuestros resultados fueron similares en el efecto benéfico y la eficacia en la calidad de vida e incontinencia urinaria, respectivamente, y se reportan porcentajes de éxito mayores al 50% en el cese total de los episodios de incontinencia.ConclusionesLa neuromodulación mediante la estimulación del nervio sacro es una forma exitosa de tratamiento en los trastornos de vaciamiento vesical de etiología no obstructiva y refractaria al tratamiento médico, es segura, mínimamente invasiva y de fácil aplicación, y mejora la calidad de vida de los pacientes. Sin embargo, es necesario realizar estudios aleatorizados y que consideren parámetros objetivos (urodinámicos), así como las complicaciones posibles a mediano y largo plazo en este tipo de terapia.AbstractBackgroundSince 1980, sacral neuromodulation therapy has been shown to be a valid alternative therapy in the management of urinary disorders due to lower urinary tract pathology, and its primary indications are: idiopathic urinary retention, urge incontinence, and fecal incontinence. It is still considered a novel therapy in Mexico and there are no studies using quantitative parameters that evaluate its efficacy in terms of quality of life.AimsTo establish the efficacy of the Medtronic InterStim® sacral neuromodulation therapy in the management of patients with bladder voiding disorders through urodynamic and quality of life analyses before and after treatment. Urine volume, periods of incontinence, patient satisfaction, and quality of life were determined.MethodsA comparative urodynamic and quality of life evaluation was carried out using the SF-36 v2 (Mexican version) and the ICIQSF instruments on patients presenting with nonobstructive bladder voiding disorders that were refractory to medical treatment.ResultsTen patients with the following diagnoses were included in the study: detrusor sphincter dyssynergia, overactive bladder, and nonobstructive urinary retention. Two of the patients were men and 8 were women. There was a 50% or greater improvement in all 10 patients during the test phase of the neuromodulation therapy and the definitive placement phase produced the following results: a 50-65% improvement in the qualitative parameters of physical function, social function, and emotional role, as well as in the quantitative variables of voiding volume, voiding efficacy, and reduced periods of incontinence.DiscussionOur results were similar to those established in the international literature in relation to the beneficial effect on quality of life and efficacy in urinary incontinence management; the literature reports success percentages in the complete cessation of incontinence episodes at above 50%.ConclusionsNeuromodulation through sacral nerve stimulation is a successful form of treatment of nonobstructive and medical treatment-refractory bladder voiding disorders. It is safe, minimally invasive, and easy to apply and it improves patient quality of life. Nevertheless, further randomized studies on this type of therapy need to be conducted that take into account objective parameters (urodynamics) and possible medium and long-term complications

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time, and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space. While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes, vast areas of the tropics remain understudied. In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity, but it remains among the least known forests in America and is often underrepresented in biodiversity databases. To worsen this situation, human-induced modifications may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge, it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Prospective comparison among three intrarectal anesthetic treatments combined with periprostatic nerve block during transrectal ultrasonography-guided prostate biopsy.

BACKGROUND: Recent trends in prostate biopsy analgesia suggest a combination anesthetic to provide better pain relief than periprostatic nerve block (PPNB) alone. This study aimed to demonstrate the efficacy and safety of three intrarectal local anesthesia (IRLA) combined with PPNB in patients undergoing transrectal ultrasonography (TRUS)-guided prostate biopsy. METHODS: In this prospective, randomized study, 120 prostate biopsy patients were equally divided into four IRLA groups: group 1 (placebo) received simple lubrication; group 2 received 2% lidocaine gel; group 3 received 100 mg indomethacin suppository and group 4 received 5% prilocaine/lidocaine (EMLA) cream. PPNB with 2% lidocaine was applied in all groups. A ten-point visual analog scale evaluated both pain associated with the probe insertion and pain associated with prostate sampling. Adverse effects or complications due to anesthesia during and after the procedure were documented. RESULTS: Compared with group 1, groups 3 and 4 had significantly lower pain scores at both probe insertion and prostate sampling while group 2 showed no significant differences at both pain scores. Moreover, group 4 showed significantly lower pain scores at probe insertion compared to group 3, while no significant difference was observed at prostate sampling. Mild complications were observed in all groups with no significant difference in the incidence of complications between groups. CONCLUSION: Intrarectal application of EMLA cream is a more efficient pain reduction than either 2% lidocaine gel or 100 mg indomethacin suppository when applied combined with PPNB. This combination represents an effective option of pain relief for patients undergoing TRUS-guided prostate biopsy

Uso de un gel polimérico para evitar migración durante la litotripsia en un paciente con litiasis ureteral

ResumenLos resultados de la litotripsia láser en litos ureterales pueden verse afectados por la retropulsión que ésta ocasiona, condicionados por la frecuencia y la energía utilizadas. Se han probado diversos dispositivos antiretropulsión con la finalidad de mejorar las tasas de resolución de los litos, sin costos agregados producidos por la migración de los mismos. El BackStopTM es un gel polimérico con termosensibilidad reversa, que ha sido probado en varios estudios con buenos resultados. El objetivo de esta experiencia es describir la eficacia y la seguridad del BackStopTM como dispositivo de antiretropulsión, en un paciente con litiasis ureteral de porción distal sometido a litotripsia intracorpórea con láser holmium.Se sometió a un paciente con litiasis ureteral derecha de porción distal a ureteroscopía rígida a litotripsia intracorpórea con láser holmium, con fibra de 365 nm, con una energía de 2 J y frecuencia de 8 Hz, previa aplicación de BackStopTM dentro del uréter.Se realiza litotripsia fragmentando en su totalidad el lito, sin presencia de migración de fragmentos a las cavidades y sin presencia de retropulsión, no se presentaron complicaciones transoperatorias durante la utilización del gel.El BackStopTM es un dispositivo seguro y eficaz para disminuir la migración en litos ureterales, en pacientes que son sometidos a ureteroscopía con litotripsia láser.AbstractThe results of laser lithotripsy in ureteral stones can be affected by the retropulsion it causes due to the frequency and energy utilized. Different anti-repulsion devices have been tested for the purpose of improving stone resolution rates and eliminating the additional cost produced by stone migration. BackStop™ Gel is a polymer with reverse thermal sensitivity that has been tested in various studies with good results. Our aim was to describe the efficacy and safety of the BackStop™ as an antirepulsion device in a patient presenting with lithiasis in the distal third of the ureter who underwent Holmium laser intracorporeal lithotripsy.A patient with a stone in the distal portion of the right ureter underwent rigid ureteroscopy and Holmium laser intracorporeal lithotripsy with a 365 nm fiber, 2J of energy, and a frequency of 8 Hz, procedures that were carried out after the application of BackStop™Gel inside the ureter. The stone was completely fragmented through the lithotripsy; none of the fragments migrated to the cavities and there was no retropulsion. There were no intraoperative complications related to the use of the gel.The BackStop™ is a safe and efficacious tool for reducing ureteral stone migration in patients undergoing ureteroscopy with laser lithotripsy

Reporte de 18 casos de pielonefritis xantogranulomatosa

ResumenAntecedentesLa pielonefritis xantogranulomatosa (PXG) es una enfermedad poco usual en donde una infección subaguda del riñón junto con una obstrucción crónica desencadena de manera poco común una respuesta inmune incompleta, produciendo destrucción crónica del parénquima renal y en ocasiones exclusión funcional. Se presentan las características clínicas, de laboratorio e imagen de pacientes sometidos a nefrectomía simple con diagnóstico histopatológico de PXG.Materiales y métodosSe realizó una revisión retrospectiva de los expedientes de pacientes sometidos a nefrectomía simple, enfocándola en aquellos con diagnóstico histopatológico de PXG en el periodo comprendido del 2009-2014. Se excluyeron aquellos pacientes que en el reporte histopatológico no presentaron este diagnóstico.ResultadosSe revisaron 171 expedientes de pacientes sometidos a nefrectomía simple. Dieciocho pacientes (10.5%) tuvieron confirmación histológica de PXG, la edad media de presentación fue de 50.8 años, con un rango de 28 a 76 años. De los 18 pacientes con PXG, 8 (61.5%) tuvieron algún grado de hidronefrosis, y en 6 pacientes (46.1%) su presentación inicial fue sepsis urinaria. El género más frecuente fue el femenino (72.2%). Once pacientes (84.1%) presentaron hemoglobina menor de 10mg/dl, hubo asociación de cáncer renal y PXG en 5 pacientes (38.4%) y 2 pacientes presentaron una fístula colónica y pleural respectivamente.ConclusionesLa PXG es una entidad cuya etiología es de origen multifactorial. Obstrucción, infección, género y enfermedad litiásica son los factores más comúnmente asociados con esta entidad. Su manejo requiere tratamiento antibiótico y manejo quirúrgico urgente.AbstractBackgroundXanthogranulomatous pyelonephritis (XGP) is an uncommon disease that involves a subacute infection of the kidney together with chronic obstruction that triggers an incomplete immune response, producing chronic destruction of the renal parenchyma, and in some cases, non-functioning kidney.Material and methodsThe case records of patients that underwent simple nephrectomy within the time frame of 2009-2014 were retrospectively reviewed, focusing on those that had a histopathologic diagnosis of XGP. The patients that did not have said histopathologic diagnosis were excluded from the study.ResultsA total of 171 case records of patients that underwent simple nephrectomy were reviewed. Eighteen patients (10.5%) had histologic confirmation of XGP and their mean age at the time of disease presentation was 50.8 years, with a range of 28 to 76 years. Of the 18 patients with XGP, 8 (61.5%) had some grade of hydronephrosis and 6 patients (46.1%) had an initial presentation of urinary sepsis. The disease was predominant in women (72.2%). Eleven patients (84.1%) had preoperative hemoglobin values under 10mg/dl, the association of cancer and XGP was present in 5 patients (38.4%), and 2 patients had a colonic fistula and pleural fistula, respectively.ConclusionsXGP etiology is multifactorial. Obstruction, infection, sex, and stone disease are the most common factors associated with this entity. Its management requires antibiotic treatment and urgent surgical management

Óptica de nanopartículas y nanocompuestos

IP 1101-05-036-99of the XV latinamerican symposium on solid state physics (SlafesXV), Cartagena de Indias, Colombia, November;1 to 5, 1999 / latinamerican simposium on solid state physics(slafes XV)(15: 1999 nov. 1-5 : Cartagena de;Indias, Colombia) Guest editors J. Giraldo, L. Quiroga, R.Merlin, J.R. Leite. -- En: Physica status solidi;(b) : Basic research Vol. 220, no. 1 (july 2000): p. 1-804. --ISSN 03701972.;Oaxaca: Sociedad Mexicana de ciencia de superficies y vacio A.C., 2000. --28 cm. -- REVISTA(S): Proceedings;ARTICULOS EN REVISTA: Funcion dielectrica de un medio quepercola / Adriana Gutierrez Rodriguez, Jairo;Giraldo Gallo. -- En: Revista colombiana de un medio que percola. -- Vol.32, no. 1 (2000). -- A statistical;model for flash thermal desorption of carbon dioxide frompolycrystallinemolybdenum / L.D Lopez Carreño, A.J.;Ramirez Cuesta, L.Viscido, J.M Heras. -- En: Journal of molecular catalysis a: chemical. -- Vol. 167 (june;2001); p. 157-163. -- Diffusive like minibands in finite superlattices ofdisordered quantum wells / R.R. Rey;Gonzalez, E. Machado -- En: Brazilian journal of physics.'-- Vol. 31 no. 4(dic. 2001). -- RF sputtered a Si:H;and aGe:H films: a comparative study / A.R. Zanatta, F. Fajardo,M. Mulato, M.M. Lima, F.C. Marques, I.;Chambouleyron. -- En: Asian journal of physics. -- Vol. 9(2000); p. 681.'-- PONENCIA(S) en Congreso: Atomic;ordering in Cd1-xZnxTe for low Zn concentration: optical,thermal and structural characterization / A.;Guterrez, M.E. Rodriguez, O. Zelaya, C. Vasquez, L. Baños,JairoGiraldo Gallo. -- En: Sociedad mexicana de;ciencia de superficies y vacio A.C. 20 congreso nacional.(20:2000 ago.28 - sep.1 :Oxaca, Mexico). -