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Resumen Contexto La cirugia laparoscopica en urologia ha supuesto un avance importante, aunque no esta exenta de cierta morbilidad asociada al empleo de multiples trocares y de forma particular a la extraccion del especimen. Con intencion de disminuir esta morbilidad y de mejorar la estetica se estan desarrollado otras tecnicas, como la cirugia laparoendoscopica a traves de orificios naturales (NOTES) y la cirugia laparoendoscopica a traves de puerto unico (LESS). Se pretende revisar el estado actual de la cirugia laparoendoscopica por puerto unico en urologia. Adquisicion de evidencia Se ha llevado a cabo una revision no sistematica, a traves de una busqueda bibliografica empleando los terminos LESS y urologia desde 2007 hasta 2012. Se describen la experiencia actual LESS en urologia, sus principales indicaciones y los diferentes dispositivos de puerto unico e instrumental disponibles en el mercado. Sintesis de evidencia La cirugia LESS nace como un paso mas en la evolucion constante de la cirugia minimamente invasiva en un intento por mejorar la estetica, reducir el traumatismo quirurgico y disminuir el dolor y las complicaciones postoperatorias asociadas a la laparoscopia convencional con multiples trocares. Desde la primera descripcion en 2007, la experiencia se ha incrementado exponencialmente y la tecnica LESS, asistida o no por robot, se esta consolidando para un gran espectro de indicaciones urologicas (tanto en cirugia oncologica como reconstructiva), a mucha mayor escala que la tecnica NOTES. A pesar de que la mayoria de los datos existentes son no aleatorizados y en escasas ocasiones son comparativos, con el sesgo de seleccion que ello representa, parece evidente que el beneficio estetico y de control analgesico asociado a la cirugia LESS es real y reproducible. Las complicaciones asociadas a la misma son mayores en casos de cirugia oncologica mayor y se deben mas a la propia tecnica que al abordaje. Conclusiones Aunque el beneficio real de la cirugia LESS en urologia aun no puede cuantificarse oportunamente, la mejora cosmetica, el menor dolor y una mayor satisfaccion del paciente con su herida resultan evidentes. El entrenamiento apropiado en este tipo de procedimientos en centros de gran volumen y las constantes mejoras tecnicas en el desarrollo instrumental por parte de la industria biomedica permiten que la tecnica LESS transumbilical en urologia haya nacido para quedarse.

The total syntheses of (±)-α-lycorane and dehydroanhydrolycorine are described. The key intermediate in both approaches is the hydroindolone 5 , prepared from the [1+4] cycloaddition reaction of 1-isocyanatocyclohexene and cyclohexyl isocyanide. Alkylation of 5 with arylbromide 6 afforded 7 . Hydrolysis of enamide 7 followed by reduction of the resultant enol yielded 10 as a single diastereomer. Radical-based cyclization of this intermediate gave 11 possessing the requisite trans -fusion between rings B and C in good yield. Radical deoxygenation followed by reduction of the amide carbonyl function afforded (±)-α-lycorane. Similarly, alkylation of 5 with 6-(chloromethyl)-5-iodo-1,3-benzodioxole gave 14 . Treatment of 14 with Pd(OAc) 2 employing the Jeffery modification of the Heck reaction gave tetracycle 9 . Hydrolysis of 9 followed by oxidation with DDQ afforded 15 . Reduction of the two carbonyl functions in this material using lithium aluminum hydride afforded 4-hydroxyanhydrolycorine ( 16 ). Mesylation of the hydroxyl group led to rapid, spontaneous elimination producing anhydrodehydrolycorine.

Post-polymerization modification of poly(allylamine hydrochloride) was applied to synthesize a library of amide-linked polyelectrolytes with tethered aliphatic, aromatic, and cubyl moieties. The efficacy of amidation was determined to be between 12 and 98 %, depending on the electronics, sterics, and solubility of the amide linkage. 13C solid-state NMR was used to further validate their structure. Thermogravimetric analysis and differential scanning calorimetry analysis indicated that none of the new polymers displayed a classic melt/freeze profile, but all displayed onset decomposition temperatures smaller than 215°C. We anticipate that the structure–property relationships observed in the resulting library of graft-modified polymers can facilitate better understanding of how to design polyelectrolytes for the construction of well-defined multilayer systems.

Laparoscopic surgery in urology is considered to be an important advance, although it is not exempt from some morbidity associated to the use of multiple trocars and specifically to the extraction of the specimen. In order to decrease this morbidity and improve esthetics, other techniques are being developed, such as natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). It is aimed to review the current status of laparoendoscopic single site surgery in urology.A nonsystematic review has been carried out by means of the bibliographic search using the terms LESS and Urology from 2007 to 2012. The current LESS experience in urology is described, and its principal indications and the different single site devices and instruments available on the market are described.LESS surgery arose as one more step in the constant evolution of minimally invasive surgery in an attempt to improve esthetics, reduce surgical trauma and decrease pain and the post-operative complications associated to the conventional laparoscopy with multiple trocars. Since it was first described in 2007, the experience has been increasing exponentially and the LESS technique, whether assisted or not by robot, is becoming consolidated for a large spectrum of urological indications (both in oncological and reconstructive surgery) on a much greater scale than the NOTES technique. Even though most of the existing data are not randomized and very rarely comparative, with the selection bias that this represents, it seems clear that the esthetic benefit and analgesic control associated to the LESS surgery is real and reproducible. The complications associated to it are greater in cases of major oncology surgery and are due more to the technique itself then to the approach.Although the real benefit of the LESS surgery in urology cannot be appropriately quantified, the cosmetic improvement, less pain and greater patient satisfaction with their wound are clear. Appropriate training in this type of procedures in centers having large volumes and the continuous technical improvements in the instrumental development by the biomedical industry has resulted in the fact that the transumbilical LESS technique in urology has been born to stay.

The conjunctiva plays a key role in the protection of the ocular surface by initiating and regulating immune responses. In this study, we analyze the relative proportion of intraepithelial lymphocytes (IELs), apoptotic cells, and proliferative state in three different topographical regions of the normal human conjunctiva. Superior tarsal, superior bulbar, and inferior tarsal-bulbar-fornical conjunctival cells were collected by brush cytology from 63 healthy donors. Flow cytometry analysis showed higher levels of CD3⁺ and CD8⁺ IELs in both upper tarsal and bulbar conjunctiva than in the inferior tarsal-bulbar-fornix, where the CD19⁺ B cells were increased. For all zones two different cell populations (by cell size and complexity) were present in the apoptosis assay. The more complex cells were reduced within the inferior tarsal-bulbar-fornix when compared with the superior bulbar and tarsal areas. Less complex cells were more predominant in the inferior conjunctiva and were mainly alive. The mean proliferation index of the conjunctival epithelium was significantly lower in the superior bulbar conjunctiva than in superior tarsal and inferior fornical conjunctivas. These findings suggest that each topographical zone from normal human conjunctiva has a unique profile of immunophenotype, viability, and proliferative state that could be related to a differentiated regional functionality.

To describe the onset of a single port laparoendoscopic program to carry out oncology surgery in a Urology Service. We present the initial experience in the laboratory and in the Animal Facility with rigid precurved instruments and KeyPort reusable access element (Richard Wolf).Two surgeons experienced in laparoscopic surgery and with the help of four assistants performed a training program based on predetermined tasks performed in simulation boxes (pelvitrainer) and porcine model following the requirements of the Regional Community of Madrid to handle experimental animals.The participants in this program were initially divided into pairs made up of an experienced surgery and assistant for the predetermined multiple tasks in simulator box in order to become familiarized with the instruments. After, 20 animal sessions were conducted in which the following were performed: (retroperitoneal or pelvic) lymph node dissections (n = 20), nephrectomies (n = 40), cystorrhaphy with suture (n = 20) and uterine-vesical anastomosis (n = 20). Times needed to perform the exercises and the principal errors perceived during the performance of each one of the tasks were recorded. The tasks, of growing complexity, were performed with the instruments described in increasingly less time and with less difficulty. An accessory trocar of 3.5 mm was required to perform the in vivo sutures.The KeyPort approach has potential application in different urological applications. Standardized training allows the acquirement of skills and makes the successful implementation possible of a laparoendoscopic surgery program in humans.

Objectives: To describe the onset of a single port laparoendoscopic program to carry out oncology surgery in a Urology Service. We present the initial experience in the laboratory and in the Animal Facility with rigid precurved instruments and KeyPort reusable access element (Richard Wolf). Materials and methods: Two surgeons experienced in laparoscopic surgery and with the help of four assistants performed a training program based on predetermined tasks performed in simulation boxes (pelvitrainer) and porcine model following the requirements of the Regional Community of Madrid to handle experimental animals. Results: The participants in this program were initially divided into pairs made up of an experienced surgeon and assistant for the predetermined multiple tasks in simulator box in order to become familiarized with the instruments. Then, 20 animal sessions were conducted in which the following were performed: (retroperitoneal or pelvic) lymph node dissections (n = 20), nephrectomies (n = 40), cystorrhaphy with suture (n = 20) and uterine-vesical anastomosis (n = 20). Time needed to perform the exercises and the principal errors perceived during the performance of each one of the tasks were recorded. The tasks, of growing complexity, were performed with the instruments described in increasingly less time and with less difficulty. An accessory trocar of 3.5 mm was required to perform the in vivo sutures. Conclusions: The KeyPort approach has potential application in different urological applications. Standardized training allows the acquirement of skills and makes the successful implementation of a laparoendoscopic surgery program in humans possible. 1.144 JCR (2012) Q4, 57/73 Urology & nephrology

Minimal access cardiac surgery via minithoracotomy aims faster recovery and shorter hospital length of stay. Pain control is essential in order to achieve this goal. A study was conducted to assess the quality of post-operative analgesia and complications related to the analgesia techniques after cardiac surgery by minithoracotomy.A descriptive, observational and retrospective study was conducted on the patients subjected to minimal access cardiac surgery in our centre between the years 2009 to 2011. The patients were divided into two groups according to the type of analgesia received: analgesia through a paravertebral catheter, with an infusion of local anaesthetics (PVB group), and intravenous analgesia with opioids (IOA group). The aim of the study was to compare the analgesic quality and the complications associated to the analgesic technique, extubation time, post-surgical complications, and length of hospital stay between both techniques.A total of 37 patients underwent to a modified minimally invasive Heart-Port access cardiac surgery. Fifteen patients received analgesia through a paravertebral block and the other 22 IV analgesia with opioids. Data are shown as means and standard deviation (SD). Mean tracheal extubation time less than 4 hours was observed in 60% of the patients in the PVB group, compared to 22% in the IOA group (P.05). Length of stay in ICU for the PVB group was 1.2 (0.7) days compared to 2.2 (0.7) days in the IOA group (P.05). Mean hospital stay was 4.8 (1.2) days for the PVB group, and 5.6 (2.8) for the IOA group (P.05. No complications associated to the continuous paravertebral block were observed.PVB analgesia is an acceptable safe technique in cardiac surgery via thoracotomy which enables early extubation with optimal pain control when compared with IV analgesia with opioids.

The inflammatory pseudotumor is a rare lesion, having benign behavior and some histological heterogeneity that appears in the genitourinary tract. A series of urogenital inflammatory pseudotumors are reviewed with emphasis on their clinicopathological and immunohistochemical characteristics.A retrospective study the causistics treated between January 1981 in December 2010 was performed. It identified the cases of inflammatory pseudotumor with urogenital localization. The variables age, gender, symptoms, topography, treatment and anatomopathological and immunohistochemical characteristics of each case were analyzed.A total of 8 cases of the urogenital-located inflammatory pseudotumor are described. Of these, 6 were located in the bladder, one in the kidney and one in the epididymis. Mean age of the patients was 46.75 (± 19.84) years. Tumor presentation symptoms were macroscopic hematuria, single symptom or accompanied by symptoms of the lower urinary tract and inguinoscrotal mass. In regards to treatment in the cases of bladder localization, transuretheral ± cystectomy were performed. In the case of kidney localization, treatment was made by means of pyelotomy and exeresis, and in the case of epididymis localization, simple exeresis was performed. The anatomopathological study showed inflammatory pseudotumor in every cases, having a mesenchymal and myxoid appearance, with fusiform cells of eosinophil cytoplasm, with presence of frequent inflammatory cells. The most common immunohistochemical pattern shows positivity for the muscle-specific actin (HHF-35), vimentin and negativity for protein S-100. ALK-1 was positive and 87.5% of the cases.The inflammatory pseudotumor is a condition having good prognosis which, when there is a good histopathological and immunohistochemical diagnosis, every urologist should recognize and distinguish in order to carry out as conservative a surgical treatment as possible.

In recent decades great advances have been made in surgical procedures for treating thoracic and thoracoabdominal aorta defects. Associated mortality and morbidity rates have dropped considerably, mainly in major reference centers, but nonetheless continue to be significant. The need for new strategies to reduce mortality and morbidity has made endovascular approaches an attractive alternative for high-risk surgical patients. The most feared complications of these procedures include paraparesis and paraplegia, which have devastating consequences on patients' quality of life. We provide an updated review of the pathophysiology of spinal cord ischemia in open and endovascular surgery, as well as perioperative measures designed to protect the spinal cord in both types of procedure.

Female urethral stricture secondary to erosión by suburethral sling is an unfrequent problem of difficult solution. Ventral vaginal rotation flaps or buccal mucosa dorsal grafts are not useful because this type of stricture is very proximal (close to the bladder neck) and the vagina is thinned. We present our experience to manage this problem using excision of disease urethral tract, associated to bladder mucosa flap and vaginal sling using transverse vaginal flap to repair the weakened vaginal wall.Three females with urethral stricture secondary to urethral erosion of their sling were treated with a technique of combined urethroplasty with bladder flap and vaginal reinforcement with pediculated vaginal flap transferred in a mini-sling fashion. Two of the patients suffered chronic urinary retention and preoperative placement of urethral catheter was not possible. The patients were evaluated 12, 36 and 55 months after surgery, respectively.Surgery was performed without complications. Results were satisfactory in all the patients, reaching good micturition postoperative caliber and being without incontinence at follow-up.Patients with suburethral erosion by a synthetic sling and secondary severe urethral stricture need total extirpation of the mesh and complete reconstruction of the urethro-vaginal septum. Tension-free urethral suture and use of vaginal sling with the technique here described are two useful technical tips for this problem.

Current surface conditions (strong oxidative atmosphere, UV radiation, low temperatures and xeric conditions) on Mars are considered extremely challenging for life. The question is whether there are any features on Mars that could exert a protective effect against the sterilizing conditions detected on its surface. Potential habitability in the subsurface would increase if the overlaying material played a protective role. With the aim of evaluating this possibility we studied the viability of two microorganisms under different conditions in a Mars simulation chamber. An acidophilic chemolithotroph isolated from Rio Tinto belonging to the Acidithiobacillus genus and Deinococcus radiodurans, a radiation resistant microorganism, were exposed to simulated Mars conditions under the protection of a layer of ferric oxides and hydroxides, a Mars regolith analogue. Samples of these microorganisms were exposed to UV radiation in Mars atmospheric conditions at different time intervals under the protection of 2 and 5 mm layers of oxidized iron minerals. Viability was evaluated by inoculation on fresh media and characterization of their growth cultures. Here we report the survival capability of both bacteria to simulated Mars environmental conditions.

Outcomes of surgical treatment of the descending thoracic aorta have improved markedly, although high associated morbidity and mortality continue to be a concern. Endovascular treatments are therefore attractive alternatives to open surgery. We compared outcomes of endovascular treatment to outcomes of open surgery on both aortic segments.Retrospective study of patients treated for descending thoracic and thoracoabdominal aorta disease by means of open surgery or endovascular treatment in our hospital between 1995 and 2009. We analyzed preoperative characteristics, intraoperative variables, and postoperative results in both groups.We retrieved the cases of 22 patients, 10 who underwent open surgery and 12 who received endovascular treatment. Surgery was indicated to treat aneurysm (40%), aortic dissection (30%), or both (30%) in the open surgery group. In the endovascular treatment group, 66.7% had aneurysm, 33.3% dissection, and 0% both. Trauma was involved in 20% of the open surgeries and 16.7% of the endovascular procedures. Forty percent of the open surgery cases and 16.2% of the endovascular interventions were emergencies. Patient age was the only statistically significant between-group difference in preoperative characteristics. Postoperative complication rates were similar. Significant differences were observed in duration of surgery, lengths of critical care unit and total hospital stays, and intubation time (P.05).The incidence of postoperative complications in the group of patients undergoing open surgery on the descending thoracic aorta was similar to incidences reported by other hospitals with moderate caseloads. A trend toward reduced morbidity and mortality in the endovascular treatment group was observed, and this group had significantly shorter times of intubation and lengths of critical care unit and hospital stays.

Enantioselective total syntheses of the antitumor alkaloids, (+)-narciclasine and (+)-pancratistatin, are reported. These syntheses feature a stereo- and regiocontrolled aryl enamide photocyclization to construct a common, advanced intermediate possessing a trans-fused BC substructure. Differential functional group interchange in the C-ring of this phenanthridone core structure allows for the production of the two target natural products in enantiomerically pure form.

To analyze clinical records of cardiac surgery patients in an attempt to identify factors associated with mortality in the postoperative critical care units of the public health service hospitals in the Community of Valencia, Spain, in 2007.Retrospective study of cases from January 1, 2007 to December 31, 2007. The charts of all patients who underwent cardiac surgery with or without extracorporeal circulation were reviewed. A data collection protocol was followed to obtain information on age, sex, body mass index (BMI), presurgical risk factors, type of surgery, duration of extracorporeal circulation, duration of ischemia, cause of death, and length of stay in the postoperative critical care unit.The study population consisted of 2113 patients at 5 public hospitals; 124 patients (70 men, 54 women) died. The mean (SD) age was 70 (9.43) years (range, 36-91 years). The mean BMI was 28.19 kg/m2 (maximum, 42 kg/m2). The mean Euroscore was 21.92 (maximum, 94.29). Hypertension was present as a preoperative risk factor in most patients (74.2%); dyslipidemia was present in 51.6%, diabetes mellitus in 38.7%, stroke in 73%, and renal failure in 2.4%. It was noteworthy was that the group who underwent coronary revascularization had the highest mortality rate (nearly 35% of the 124 patients). The next highest mortality rate (19.4%) was in patients who had combined procedures (valve repair or substitution plus coronary revascularization). Mortality was 18.5% in the group undergoing aortic valve surgery and 11.3% in those undergoing mitral valve surgery. The mean duration of extracorporeal circulation was 148.63 minutes. The mean duration of myocardial ischemia was 94.91 minutes. The most frequent cause of death was cardiogenic shock (54.8%). This was followed by distributive shock (29.8%) and hemorrhagic shock (8.9%). The mean length of stay in the postoperative critical care unit was 13.6 days. Overall mortality was 5.87%.The highest mortality rate among cardiac surgery patients in postoperative critical care units in hospitals in the Community of Valencia in 2007 was in patients who underwent coronary revascularization. The most prevalent preoperative risk factor was hypertension. Cardiogenic shock and distributive shock were the most frequent causes of death in these patients. A system for classifying risk is needed in order to predict mortality in critical care units and improve perioperative care.

[1] Perchlorate salts (mostly magnesium and sodium perchlorate) have been detected on Mars' arctic soil by the Phoenix lander, furthermore chloride salts have been found on the Meridiani and Gusev sites and on widespread deposits on the southern Martian hemisphere. The presence of these salts on the surface is not only relevant because of their ability to lower the freezing point of water, but also because they can absorb water vapor and form a liquid solution (deliquesce). We show experimentally that small amounts of sodium perchlorate (∼ 1 mg), at Mars atmospheric conditions, spontaneously absorb moisture and melt into a liquid solution growing into ∼ 1 mm liquid spheroids at temperatures as low as 225 K. Also mixtures of water ice and sodium perchlorate melt into a liquid at this temperature. Our results indicate that salty environments make liquid water to be locally and sporadically stable on present day Mars.

To evaluate if an education program for the nursing staff helps to reduce the incidence of pressure ulcers and prevent their poor evolution.A prospective and observational study where the prevention and educational methods have been used to prevent and treat pressure ulcers. All patients admitted to Intensive Care Unit during one year were included (six months of basal period and six months of post-training period). The following variables were analyzed: incidence of Pressure Ulcers, risk score according to EMINA, ulcer grade and location.A total of 134 ulcers were identified in the 69 patients (14.37%) with pressure ulcers included in the basal period. Forty-four patients (7.88%) of the patients in the post-training period developed 77 pressure ulcers. The significance level was p0.01, OR: 0.40 (95% CI: 0.26-0.62). Fifteen of the 211 pressure ulcers evolved to grade III-IV p0.20.Conducting a training program in the application of standardized prevention methods for the nursing staff reduces the incidence of pressure ulcers.

International audience; The stator insulation breakdown is a major cause of AC machine failures. Ground insulation defaults are easily detected by classical systems based on leakage current measurements, however the turn-to-turn insulation degradations are more difficult to detect. For large machines, on-line methods, based on partial discharge detection and analysis, give good results but they cannot be used for low-voltage machines fed by adjustable speed drives (ASD). A new monitoring system able to detect slight variations of high frequency resonances in the winding of a working machine fed by an industrial inverter was presented in [1]. Several measurements can be used in order to estimate the aging of an AC machine winding (HF measurements of current or magnetic field) [2]. When a measure, also called a piece of information, is precise and certain, no other measure is necessary. However, such a measure is rarely obtained in real world application. Information fusion consists then in merging, or exploiting conjointly, several imperfect sources of information to make proper decision. Various frameworks can be used to model the fusion, e.g., probability theory, possibility theory, belief functions [3,4]. In this paper, different measurements of the aging of an AC machine winding are combined in the latter frame. This approach is tested on real measurements.

The aims of this study were to assess adherence to oral hypoglycaemic/cardiovascular drugs and determine non-adherence predictors in type 2 diabetes patients. It was designed as a population-based cross-sectional study in which 90 patients from a primary care setting were studied. Pill count and self-report methods were used to measure adherence. Logistic regression analysis was performed to predict factors related to non-adherence. Adequate adherence to all drugs was found in 29 patients (35.4%; 95% confidence interval (CI) 25.0-45.7). Variables associated with non-adherence were HbA1c odds ratio (OR) 2.32 (95% CI: 1.09-4.95), systolic blood pressure OR 1.68 (95% CI: 1.08-2.62), total cholesterol OR 1.34 (95% CI: 1.08-1.66), number of pills OR 1.80 (95% CI: 1.26-2.55) and duration of disease OR 0.44 (CI 95%: 0.24-0.83). In conclusion, one in three patients had adequate adherence. Factors associated with non-adherence were duration of disease, complexity of drug regimen and inadequate control of cardiovascular risk factors.

(S)-Cysteine has been deposited on a Cu110 surface from sublimation of a crystalline phase. The surface was characterized by Fourier transform reflection absorption infrared spectroscopy (FT-RAIRS) during exposure and compared to the same copper surface after immersion into cysteine solutions at various pH values. X-ray photoelectron spectroscopy (XPS) measurements provided a chemical characterization of the surface at certain stages. The combination of these two techniques highlighted the importance of the cysteine "source" for the adsorbed form of the molecules and the mode of interaction. The zwitterionic amino acid was found to be predominant after adsorption at pH values close to the isoelectric point (IEP) of the molecule but also when the layer was formed in the vapor phase. This state was very sensitive to the atmosphere, contained an excess of hydroxyls, and/or underwent reduction into the anionic form when in contact with water or air. Weakly bound cysteine or cystine molecules, formed in the adsorbed phase, were considered to explain the average thickness of the adsorbed layer that was close to 20 A. As expected, immersion in very acidic or very basic solutions led to cationic and anionic forms, respectively.

This paper deals with dynamic equilibrium of biped robots. We focus our attention on balance of a planar biped standing upon one small foot. The trunk and leg on contact can be seen as a double-inverted pendulum without actuators at the contact point but with a controlled counterweight corresponding to the free leg. We identify all the singular points of this structure before making a linearization and deriving a state feedback control law. A description of the prototype is then described.

Severe sepsis and septic shock (SS/SS) have a high mortality. Therapeutic guidelines can improve mortality, but early recognition and timely implementation of these requires a proactive attitude that can be electronically supported.

To describe complications and mortality in patients diagnosed of Stanford's type A (Daily) dissection of the ascending aorta requiring circulatory arrest for emergency placement of an aortic graft.Retrospective study of 21 patients treated between December 1992 and November 1997.Hypertension was the disease most often associated with the diagnosis (in 8 of the 21 patients). Preoperative mortality was 9.5% (2 of the 21 patients), no deaths occurred in the operating room and postoperative mortality was 15.8% (3 of the 19 patients who underwent surgery). Durations in mean time (SD) in minutes were as follows: anesthesia-surgery 437.9 (92), extracorporeal circulation 192.5 (47), aortic clamping 82.6 (20), circulatory arrest 30.5 (8). Retrograde cerebral circulation was carried out during circulatory arrest in all cases. Mean temperature during this period was 14.9 degrees C. During the postoperative period we recorded three permanent neurological complications, six cases of acute renal failure and seven respiratory complications, specifically one instance of adult respiratory distress syndrome and six of pneumonia, the most common. Consumption of blood products was high, with great interindividual variation.Anesthesia for and recovery from surgery for acute aortic dissection is complex and associated with a high rate of postoperative complication and high consumption of blood products.

The APACHE II and TISS scales usually are used in intensive medicine services to assess patient's severity and therapeutic requirements, respectively. Both scales serve to classify ICU patient's into three care levels, each of which has its own well-defined surveillance and care requirements. Nursing personnel have used the TISS scale to determine work loads and plan nurse-patient ratios. However, this scale is complex and its application is time-consuming, thus impeding its routine use. In recent years, the NEMS (Nine Equivalents of Nursing Manpower) scale has been validated for this purpose. This scale uses just nine variables to objectively quantify nursing requirements. In order to determine if the NEMS scale could be used to evaluate the severity and nursing requirements of patient's admitted to our ICU and to establish care levels, we designed a descriptive study of a sample of 78 patients. The results showed that the APACHE II, TISS and NEMS scales has a good correlation and that the NEMS scale could be used to determine patient care requirements in our service. Based on the TISS and NEMS correlation, we determined discriminative numerical NEMS values for assigning patient's to different care levels.

We describe our experience in managing single lung ventilation (SLP) with the Univent bronchial blocker tube from 1993 to the present.Patients were grouped based on the following criteria: use of a double lumen tube as an alternative to SLP (group 1), use of SLP and tracheotomy (group 2), or difficult or dangerous orotracheal intubation (group 3).The mean age of the 32 patients (22 men and 10 women) studied was 45.7 +/- 12.2 years. Mean weight was 67.9 +/- 13.4 kg. Ten patients were physical status ASA I, 10 were ASA II, 10 were ASA III and 2 were ASA IV. Group 1 contained 28 patients (18 receiving right SLP and 10 receiving left SLP; use of SLP failed to collapse the lung in 4 patients [14.3%]). Group 2 consisted of 5 patients and group 3 contained 11. The Univent tube was used in 4 patients in group 3 who did not require use of SLP but whose intubation was considered difficult and in whom laryngoscopic findings were consistent with a Cormack-Lehane group III classification. The Univent bronchial blocker tube was used as a guide, such that intubation was achieved on the first try. The tube was removed from 3 patients (8%) in the intensive care recovery ward. The remaining 29 tracheas were extubated in the operating room. No side effects attributable to the Univent tube were recorded.The advantages and disadvantages of this new tool for the management of SLP mean that it may be useful for specific situations (such as for SLP with difficult intubation or in patients with tracheotomies or aneurysms of the descending thoracic aorta), but that it does not replace conventional methods. We believe that the Univent bronchial blocker tube should be available as part of operating room equipment.

Tracheostomic clyster pipes are mechanisms which allow one to artificially maintain the permeability of the air passageway under those circumstances when it is not possible to breathe by the conventional way. Nowadays, there is a wide variety of clyster pipes available to medical professionals. Each of these has its own traits and precise applications. This article describes those clyster pipes most frequently used in hospitals and outpatient clinics; furthermore, their use, care and therapeutic applications are mentioned.

To evaluate the monitoring of intramucosal pH (pHi) and standard pH (pHs) during heart surgery with extracorporeal circulation (ECC) and moderate hypothermia. The correlations of pHi and pHs and the postoperative APACHE III score after surgery were analyzed.Sixteen patients with cardiac output0.4 scheduled for coronary bypass surgery, or aortic or mitral valve replacement were studied. Arterial pH (pHa), pHi and pHs were measured and the difference between pHa and pHi was calculated before starting ECC (T0), during ECC and hypothermia (T1) and after termination of ECC (T2). The APACHE III score was recorded 18 h after surgery.No significant differences between the pHi and pHs were observed in these patients. pHi was significantly higher during ECC with hypothermia (T1) than at baseline (T0). pHi and pHs were significantly correlated during the study period. There was no correlation between the APACHE III score in the immediate postoperative period and either pHi or pHs during surgery.Periods of splanchnic hypoxia (pHi7.32) during heart surgery with moderate hypothermia were not seen in patients with cardiac output0.4. pHs is a reliable measurement of pHi. There is no relation between APACHE III scores in the early postoperative period and pHi or pHs levels during surgery.

Using different catheters to inject or infuse drugs into patients veins, as well as drawing blood samples, are part of the daily hospital routine for nursing personnel. There are many documented accounts written about these instruments, most by professional experts and therefore usually very technical in nature. This technical aspect presents a stumbling block for nursing personnel who are studying or just starting their practice. The purpose of this article is to present a practical, simple description of the different types of peripheral access catheters, their use and maintenance.

As stated in a recent document of the National Committee for Clinical Laboratory Standards (NCCLS Document C42-P, April 1995), expression of the results of erythrocyte zinc protoporphyrin (ZPP) in different units is a main source of confusion which may hamper the wide use of this test. The possible inter-conversion of the ZPP values expressed as microgram/g Hb, microgram/dL blood and microgram/dL red cells was assessed. It was found that in all cases, despite a good correlation between these values (ror = 0.939), the error of the estimation was higher than allowed by the American College of Pathologists criteria. Such findings show that ZPP values expressed in different units cannot be inter-converted as a function of the corresponding regression equation. Similarly, the use of hematofluorometers with an analogic-digital converter to express results as microgram ZPP/ dL blood might pose an additional source of error.

Resultados postoperatorios de dos pautas de ácido tranexámico (AT) durante circulación extracorpórea (CEC). Métodos: Estudio retrospectivo. Ciento cuarenta y cuatro pacientes consecutivos en tres centros de la Comunidad Valenciana. Criterios exclusión: urgente/emergente; reoperación; cirugía aórtica; suspensión acenocumarol inferior a 2 días y clopidogrel inferior a 5 días; historia de anemia/trombopatía/ coagulopatía; tiempo CEC superior a 300 min; creatininemia superior a 2 mg/dl; alérgicos al AT. Grupo A (72 pacientes): carga 20 mg/kg + perfusión 4 mg/kg/h + 100 mg cebado CEC. Grupo B (72 pacientes): carga de 10 mg/kg + perfusión 2 mg/ kg/h + 50 mg cebado CEC. Variables pre/intraoperatorias y postoperatorias (débito en 6, 12 y 24 h, número/tipo de hemoderivados en primeras 24 h, reintervención por sangrado, eventos adversos en primeras 48 h). Pacientes con sangrado superior al percentil 90 en cada una de las horas registro se consideraron con sangrado aumentado. Resultados: Grupos comparables. La incidencia de sangrado aumentado fue superior en el grupo B a las 6 y 12 h (p < 0,05). El grupo B presentó mayor necesidad de reintervención por sangrado (5,56 [4] vs 1,39% [1]; p = 0,172). El grupo A presen-tó un caso aislado de convulsiones. No existieron diferencias significativas en necesidades transfusionales. La incidencia conjunta de sangrado aumentado + reintervención + transfusión igual o superior a tres concentrados de hematíes fue inferior en el grupo A (5,56% [4]) vs grupo B (13,89% [10]); p = 0,044. El análisis multivariante demostró que la pertenencia al grupo A fue un factor protector independiente de eventos de sangra-do excesivo en las 6 h (odds ratio [OR]: 0,615; p < 0,017), 12 h (OR: 0,794; p = 0,042) y del evento adverso conjunto (OR: 0,615; p = 0,002). Conclusiones: La pauta de AT del grupo A reduce significativamente el sangrado en las primeras 12 h del postoperatorio frente a la del grupo B, aunque no ha demostrado reducir las necesidades transfusionales.