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This article is a systematic review of studies that have investigated the initial management of patients with psychiatric conditions in hospital emergencies services in order to establish practical recommendations. A systematic review of the literature was carried out, consisting of studies published from 2010 to 2020, available in any language, consulting Cochrane Library Plus, PubMed, IBECS, LILACS and MEDLINE. The quality of the studies included in this review was assessed by the AMSTAR2 tool and the FCL 3.0 platform, together with the PRISMA statement. Results from the eleven papers selected showed that improvements in staff training, available resources, appropriate use of restraint and appropriate choice of medication can help to improve the care of patients with mental pathology in hospital emergency services. The same management for any other patient is recommended. However, if the patient is agitated or uncooperative, verbal, pharmacological and/or mechanical restraint (in this order) may be necessary. Keywords. Psychiatry. Psychomotor agitation. Crisis intervention. Hospital emergency service.

Background: To calculate the prevalence of excessive daytime sleepiness (EDS) (through the Epworth Sleepiness Scale, ESE) and to identify the personal and working variables predicting the risk of EDS., Methods: Cross-sectional study performed on 476 civil servants from Murcia (October 2013 - February 2016). Prevalence of EDS and bad sleep hygiene (LSH) were determined from scores on the Epworth Sleepiness Scale and Sleep Hygiene Scale (SHS), respectively, and their association with different variables was obtained from a self-administered questionnaire. Independent predictors of EDS were identified by multivariate logistic regression., Results: EDS was less prevalent (16.7%) than LSH (23.4%). Women scored higher in ESE (7.5 vs 6.3; p=0,001) and suffered twice the EDS of men (23.0 vs 10.7%, p<0.001). Workers with EDS scored higher on SHS (34.3 vs 32.7; p=0.044) and had LSH more frequently (38.7 vs 24.9%, p=0.014). Smokers were predominantly women (57.0%; p=0.087) with LSH (50.0 vs 25.8 and 18.9% amongst ex-smokers and non-smokers, p<0.001). Being a woman OR=2.5, 95%IC: 1.4-4.3; p<0.001) and having bad sleep hygiene (OR=1.8 95%IC: 1.0-3.2, p=0.032) were predictive factors irrespective of suffering from EDS., Conclusions: EDS was present in civil servants in the region of Murcia, and was higher in women than men. Excessive daytime sleepiness is strongly associated with bad sleep hygiene and became a woman.

Objectives: The diagnosis of low clinical stage renal cancer has risen up during the last years thanks to the advances on radiological imaging tools. As a result, several minimally invasive techniques have appeared which offer the same oncological results than conventional/laparoscopic surgery without their morbidity. One of these techniques is percutaneous radiofrequency (RF). In this paper we expose the oncological and functional outcomes of percutaneous RF after a review of the literature., Methods: We made a search using the principal medical libraries as the Cochrane Central of clinical controlled trials, Medline and the Excerpta Medica database.We used the following terms: "renal radiofrequency ablation US guided", "renal radiofrequency ablation CT guided ", "renal radiofrequency ablation MR guided"," renal radiofrequency ablation "," renal radiofrequency ablation image guided". A methodological and clinical expert analyzed each abstract.All studies where renal cancer or small renal masses were treated were included. We excluded series with hereditary renal cancer only or metastatic cancer, technical series and those where tumor recurrence or other oncological criteria were not evaluated. Data collection included patient age, tumor size, follow up and oncological data. The oncological data evaluated included: tumor local recurrence (radiological or pathologic evidence of residual disease after initial treatment, independently of time to recurrence, accordingly to the recommendations of the Working group on image guided tumor ablation) or distant metastases., Results: There were a total of 1621 papers. Only 24 met the inclusion criteria, and we only found 1 controlled trial, and several retrospective studies and series of cases. A total of 11, 10 y 3 for US, CT and MR guided RF, respectively, with a follow up of 1-57 months, with a total of 1764 tumors in 1524 patients. Tumor size was 1 to 8.9cm and local recurrence between 0%-5.06%., Conclusions: Surgical treatment remains the "gold standard" for clinical stage I renal cancer because we do not have enough long term scientific information to be sure that percutaneous renal RF offers the same oncological results than surgery, but percutaneous renal RF is an option for those patients that are not candidates to surgery.

Objectives: Hyperbaric oxygen therapy (HBO) has been successfully used in several disorders derived from tissue hypoxia, due to the extra oxygen supply to the tissues it enables. In this manuscript we performed a systematic review including all the existing data published until 2010 about HBO in urologic disorders., Methods: We performed a Medline search using the terms "hyperbaric oxygen", "radical cystitis", "interstitial cystitis", "hemorrhagic cystitis", "urological/pelvic fistula"and "Fournier's gangrene". The search was restricted to human clinical trials published in any language., Results: We found 56 papers: 1 randomized controlled trial, 7 reviews and 48 case reports; only one of them was a prospective study. A total of 695 patients were included. Just one study used tissue oxygen measurement to define hypoxia. The number of hyperbaric oxygen therapy sessions ranged from 4 to 44 (mean 19.2 sessions/patient)., Conclusions: The level of evidence from most reviewed papers is low because most of them are case series. Nevertheless, results of most of those studies regarding patient management are good or very good. So it seems that HBO can be very useful in urological diseases related to tissue hypoxia.

Objective: To report a brucellar orchiepididymitis case and to review the diagnosis and treatment of this pathology., Method: We present the case of a 62 year old man presenting with fever, testicular pain and constitutional syndrome. The diagnosis was made after ultrasound, blood cultures and anamnesis., Results: The treatment was Doxiciclin six weeks and teicoplanin, the second one was replaced with ciprofloxacin., Conclusion: It is important to make a correct anamnesis to the patient with orchiepididymitis to identify any risk factor for brucellosis. The diagnosis is confirmed with blood cultures. The oral antibiotics are enough to cure patients.

Objectives: To determine the efficacy in the prevention of tumor recurrence, disease free interval and side effects of intravesical epirrubicin post-TUR of superficial bladder tumor., Methods: From February 1993 to November 1997, 57 patients with stage Ta, T1, grade I, II and III tumor of the bladder were studied. These patients were treated with 50 mg epirrubicin in 50 ml saline solution administered intravesically on 15 occasions for one year after surgery. The mean follow-up was 18 months. The follow-up protocol included clinical, analytical, cytological, US and cystoscopic control evaluations every 3 months for the first year, every 6 months for the second and third year, and yearly thereafter., Results: At a mean follow-up of 30.2 months, 31.5% (18/55) of the patients showed tumor recurrence; the disease free interval was 17 months for the remaining 18 patients and 43 months for the overall group. Cystitis was observed as an adverse effect in 5 of 57 patients (8.8%)., Conclusions: The study shows that prophylactic treatment with intravesical epirrubicin for the prevention of recurrence in superficial bladder tumor has few side effects and its efficacy is similar to that reported in other studies.

One gm ceftriaxone was administered i.m. to 266 patients 1 h before urologic surgery. The antimicrobial spectrum and long half life of this beta-lactam make it potentially useful for prophylaxis. Its efficacy was determined by the incidence of infections and antibiotics required postoperatively. Postoperative bacteriuria was determined by two urine cultures: one at discharge from hospital or after catheter removal and another 4 weeks postoperatively. The overall postoperative infection rate was 9.7% and bacteriuria was 11.2%; most of these were asymptomatic. Antibiotics were administered postoperatively in 13.9% of the patients. The foregoing results corroborate the efficacy of this agent given in a single dose for prophylaxis against infection in urologic surgery.

We report a case of retroperitoneal ganglioneuroma that had been incidentally discovered during ultrasound evaluation in a young female patient. The plain X-ray, IVP and ultrasonography only revealed the presence of a retroperitoneal mass and its approximate size. CT and arteriography provided further information relative to the location, nature of the extrarenal mass, its borders, and size although these did not permit us to determine its origin.

The authors present 6 cases of torsion of Morgagni's hydatid treated in the Emergency Urology Department over a two-year period. They stress the importance of the clinical diagnosis, as well as the differential diagnosis with other "acute, testicular bag" processes, in particular with funicular torsion. Surgical treatment is the only way of overcoming the pain, confirming the diagnosis and preventing the risk of secondary, testicular atrophy.

Fourteen cases of angiomyolipoma have been diagnosed and treated at our center since it opened 19 years ago. The diagnostic methods and therapeutic approach have changed since then. Noninvasive imaging techniques like CT and ultrasound have significantly enhanced the accuracy of diagnosis. The mode of presentation, number, size and the differential diagnosis may decide between conservative or surgical management of these tumors. A small tumor mass only requires observation. For larger ones, the treatment of choice is preferably by conservative surgery or highly selective embolization if permitted by the severity of the disease. Surgery is warranted when doubt exists on CT and ultrasonography.