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991.
M. Cintra-Cabrera A. Suárez-Benjumea G. Bernal-Blanco F.M. González-Roncero N.G. Toapanta-Gaibor M. Súñer-Poblet M.Á. Pérez-Valdivia F. Fernández-Cuenca M.Á. Gentil-Govantes J.L. Rocha-Castilla 《Transplantation proceedings》2018,50(2):575-577
Background
Resistant cytomegalovirus (R-CMV) is an emerging problem in the renal transplantation population. The most frequent CMVs are high-resistance mutations (UL97 gene).Methods
We describe our experience in management of R-CMV after renal transplant at our center (2012–2016).Results
We encountered 3 cases of R-CMV infection after renal transplant (all primary infections). All 3 patients received induction therapy with corticosteroids, tacrolimus, and mycophenolate mofetil. The first patient (basiliximab induction, preemptive CMV) developed CMV replication on day +53, which responded poorly both to standard-dose valganciclovir (vGCV) and high-dose ganciclovir (GCV) (creatinine clearance [CrCl] >70 mL/min; vGCV 900 mg twice daily for 50 days and GCV 7.5 mg/kg twice daily for 8 days). Hematologic toxicity occurred. The R-CMV test was positive and foscarnet (FOS) was initiated (90 mg/kg twice daily for 21 days). The second patient presented CMV infection (day +30, thymoglobulin induction, CMV prophylaxis), which was not controlled with the high dose (CrCl 23 mL/min; GCV 3.5 mg/kg twice daily and vGCV 900 mg twice daily), resulting in severe neutropenia. R-CMV was detected and FOS initiated (FOS 50 mg/kg twice daily for 7 days and 50 mg/kg every 2 days for 13 days). The third patient's infection occurred on day +22 (basiliximab induction, preemptive CMV). Standard-dose vGCV was uneffective (CrCl >70 mL/min, vGCV 900 mg twice daily) and it did not respond to the high dose (GCV 7.5 mg/kg twice daily and vGCV 2700 mg/d). Moderate hematologic toxicity occurred. R-CMV was diagnosed and FOS treatment begun (FOS 70 mg/kg per day for 2 weeks).Conclusions
Resistant CMV infection may be severe due to viral infection and side effects of high-dose antiviral treatment. We presented 3 cases requiring the use of FOS in the absence of response or toxic effects from the usual treatment, with an optimal sustained response (temporary in case 2) and without serious side effects. 相似文献992.
993.
994.
J. Rubio-Briones A. Borque-Fernando L.M. Esteban-Escaño S. Martínez-Breijo R. Medina-López V. Hernández 《Actas urologicas espa?olas》2018,42(7):442-449
Background
Our main objective was to report the current use of active surveillance in Spain and to identify areas for potential improvement.Methods
A questionnaire generated by the Platform for Multicentre Studies of the Spanish Urology Association (AEU/PIEM/2014/0001, NCT02865330) was sent to all associate researchers from January to March 2016. The questionnaire included 7 domains covering various aspects of active surveillance.Results
Thirty-three of the 41 associate researchers responded to the questionnaire. Active surveillance is mainly controlled by the urology departments (87.9%). There was considerable heterogeneity in the classical clinical-pathological variables as selection criteria. Only 36.4% of the associate researchers used prostate-specific antigen density (PSAd). Multiparametric magnetic resonance imaging (mpMRI) was clearly underused as initial staging (6%). Only 27.3% of the researchers stated that their radiology colleagues had a high level of experience in mpMRI. In terms of the confirmation biopsy, most of the centres used the transrectal pathway, and only 2 out of 33 used the transperineal pathway or fusion software. Half of the researchers interviewed applied active treatment when faced with disease progression to Gleason 7 (3+4). There was no consensus on when to transition to an observation strategy.Conclusions
The study showed the underutilisation of informed consent and quality-of-life questionnaires. PSAd was not included as a decisive element in the initial strategy for most researchers. There was a lack of confidence in the urologists’ mpMRI experience and an underutilisation of the transperineal pathway. There was also no consensus on the follow-up protocols and active treatment criteria, confirming the need for prospective studies to analyse the role of mpMRI and biomarkers. 相似文献995.
P. Moscatiello D. Carracedo Calvo L. Yupanqui Guerra M.E. Rivera Martínez A. Mendiola de la Hoza M. Sánchez Encinas 《Actas urologicas espa?olas》2018,42(5):344-349
Introduction
Pudendal nerve entrapment syndrome (PNE) is characterised by the presence of neuropathic pain in the pudendal nerve (PN) territory, associated or not with urinary, defecatory and sexual disorders. Surgical PN decompression is an effective and safe alternative for cases when conservative treatment fails. The aim of this study is to describe the first robot-assisted pudendal neurolysis procedure performed in our country.Material and methods
We describe step by step the technique of robot-assisted laparoscopic neurolysis of the left PN performed with intraoperative neurophysiological monitoring on a 60-year-old patient diagnosed with left PNE.Results
The procedure was performed satisfactorily without complications. After 24 h, the patient was discharged from the hospital. We observed a 50% reduction in pain measured using the visual analogue scale 2 weeks after the procedure, which remained after 10 weeks of the neurolysis.Conclusions
Robot-assisted neurolysis of the PN constitutes a feasible and safe approach, enabling better visualisation and accuracy in the dissection of the PN. Intraoperative neurophysiological monitoring is useful for locating the PN and for detecting intraoperative changes after the release of the nerve. 相似文献996.
997.
S. Arlandis E. Morán E. Martínez-Cuenca M.Á. Bonillo R. Martínez-García P. Rosier 《Actas urologicas espa?olas》2018,42(10):625-631
The standardisation working group of the International Continence Society has updated the Good Urodynamic Practice directives. This evidence-based ICS-GUP2016 has defined the terminology and standards of Urodynamic practice, for the laboratory and for individual practice, in quality control during cystometry and pressure-flow analysis. In addition, the working group included recommendations prior to the test and information about how to prepare the patient, as well as recommendations for the reporting of urodynamics. Based on earlier International Continence Society standardisations and current evidence, the practice of uroflowmetry, cystometry and pressure-flow study have been detailed with a view to ensuring that this Good Urodynamic Practice update contributes towards improving clinical and research quality in urodynamics. 相似文献
998.
999.
Objectives
We aimed to explore the potential benefits of using smart glasses – wearable computer optical devices with touch-less command features – in the surgery room and in outpatient care settings in urology.Materials and methods
Between April and November 2015, 80 urologists were invited to use Google Glass in their daily surgical and clinical practice, and to share them with other urologists. Participants rated the usefulness of smart glasses on a 10-point scale, and provided insights on their potential benefits in a telephone interview.Results
During the testing period, 240 urologists used smart glasses, and the 80 initially invited rated their usefulness. Mean scores for usefulness in the surgery room and in outpatient clinics were 7.4 and 5.4, respectively. The interview revealed that the applications of smart glasses considered most promising in surgery were live video streaming and static image playback, augmented reality, laparoscopic navigation, and digital checklist for safety verification. In outpatient settings, participants considered the glasses useful as a viewing platform for sharing test results, for browsing digital vademecum, and for checking medical records in emergency situations.Conclusions
Urologists engaged in our experience identified various uses of smart glasses with potential benefits for physician's daily practice, particularly in the urological surgery setting. Further quantitative studies are needed to exploit the actual possibilities of smart glasses and address the technical limitations for their safe use in clinical and surgical practice. 相似文献1000.
J.V. Baldissera-Aradas L. Rodríguez-Villamil R. Blanco-Fernández C. Pérez-García G. Viejo de la guerra I. González-Rodríguez J. Mosquera-Madera 《Actas urologicas espa?olas》2018,42(7):465-472