6-Nitrodopamine is a novel catecholamine released by vascular tissues, heart, and vas deferens. The aim of this study was to investigate whether 6-nitrodopamine is released from the thoracic aorta and pulmonary artery rings of marmosets (Callithrix spp.) and to evaluate the relaxing and anti-contractile actions of this catecholamine. Release of 6-nitrodopamine, dopamine, noradrenaline, and adrenaline was assessed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The relaxations induced by 6-nitrodopamine and by the selective dopamine D2 receptor antagonist L-741,626 were evaluated on U-46619 (3 nM)-pre-contracted vessels. The effects of 6-nitrodopamine and L-741,626 on the contractions induced by electric-field stimulation (EFS), dopamine, noradrenaline, and adrenaline were also investigated. Both aorta and pulmonary artery rings exhibited endothelium-dependent release of 6-nitrodopamine, which was significantly reduced by the NO synthesis inhibitor L-NAME. Addition of 6-nitrodopamine or L-741,626 caused concentration-dependent relaxations of both vascular tissues, which were almost abolished by endothelium removal, whereas L-NAME and the soluble guanylate cyclase inhibitor ODQ had no effect on 6-nitrodopamine-induced relaxations. Additionally, pre-incubation with 6-nitrodopamine antagonized the dopamine-induced contractions, without affecting the noradrenaline- and adrenaline-induced contractions. Pre-incubation with L-741,626 antagonized the contractions induced by all catecholamines. The EFS-induced contractions were significantly increased by L-NAME, but unaffected by ODQ. Immunohistochemical assays showed no immunostaining of the neural tissue markers S-100 and calretinin in either vascular tissue. The results indicated that 6-nitrodopamine is the major catecholamine released by marmoset vascular tissues, and it acts as a potent and selective antagonist of dopamine D2-like receptors. 6-nitrodopamine release may be the major mechanism by which NO causes vasodilatation.

Resumo Guavira (Campomanesia adamantium, Myrtaceae) é um fruto nativo do Cerrado brasileiro e de importância sócio econômica para a população indígena e tradicional do Centro-Oeste. Esta é uma revisão bibliográfica das propriedades da guavira e seus derivados e, após a discussão de estudos experimentais, uma abordagem interdisciplinar é conduzida destacando a importância dos Sistemas Agroflorestais como uma ferramenta de restauração ecológica para alavancar a cadeia produtiva da guavira enquanto fornece serviços ecossistêmicos. Muitos grupos de pesquisa estudaram os efeitos dos polifenóis e outros compostos bioativos e propriedades biológicas desta fruta e de outras partes da planta, como antibióticos, antioxidantes, anti-inflamatórios, anti-hiperlipidêmicos, antidiarreicos e antitumorais, proteção cardiovascular e hepática e ação contra a dor neuropática. Além disso, os subprodutos da guavira beneficiam a saúde intestinal das aves, da mesma forma que os antibióticos adicionados à sua alimentação. Foram, também, encontrados diversos produtos biotecnológicos, como farinha de polpa, tempero da casca, protetor solar e óleo de semente semelhante ao azeite com potencial farmacêutico e industrial. Concluímos enfatizando a importância da guavira para a restauração e preservação do ameaçado Cerrado brasileiro e para o desenvolvimento socioambiental da agricultura familiar. A mesma abordagem e estudo são bem-vindos e necessários em outras regiões e domínios em todo o mundo, tendo sua flora nativa como meio para um fim restaurador. Campomanesia adamantium Myrtaceae CentroOeste. CentroOeste Centro Oeste. Oeste Centro-Oeste experimentais ecossistêmicos planta antioxidantes antiinflamatórios, antiinflamatórios anti inflamatórios, inflamatórios anti-inflamatórios antihiperlipidêmicos, antihiperlipidêmicos hiperlipidêmicos, hiperlipidêmicos anti-hiperlipidêmicos antitumorais neuropática disso aves alimentação Foram também biotecnológicos polpa casca industrial familiar bemvindos bem vindos mundo restaurador

Abstract Guavira (Campomanesia adamantium, Myrtaceae) is a native fruit from the Brazilian Cerrado savanna and is socio-economically important for the indigenous and traditional people living in the Central-West. This is a bibliographic review of the biological properties of guavira and its derivatives, and, after discussing experimental studies, an interdisciplinary approach is conducted highlighting the im-portance of Agroforestry Systems as an ecological restoration tool to leverage the production chain of guavira while providing ecosystem services. Many research groups studied effects of polyphenols and other bioactive compounds and biological properties of this fruit and other plant parts such as antibiotic, antioxidant, anti-inflammatory, anti-hyperlipidemic, anti-diarrheic and antitumoral activities, cardiovascular and hepatic protection and action against neuropathic pain. Besides, guavira by-products benefit poultry intestinal health, similarly to antibiotics added to their feed. Furthermore, several biotechnological products were found, like pulp flour, seasoning from the peel, sunscreen, and seed oil similar to olive oil with pharmaceutical and industrial potential. We conclude by emphasizing the importance of guavira for restoration and preservation of the threatened Brazilian Cerrado, and for the socio-environmental development of family agriculture. The same approach and study are welcome and necessary in other regions and domains worldwide having their native flora as means for a restorative end. Campomanesia adamantium Myrtaceae socioeconomically socio economically CentralWest. CentralWest Central West. West Central-West derivatives studies im portance services antibiotic antioxidant antiinflammatory, antiinflammatory anti inflammatory, inflammatory anti-inflammatory antihyperlipidemic, antihyperlipidemic hyperlipidemic, hyperlipidemic anti-hyperlipidemic antidiarrheic diarrheic activities pain Besides byproducts health feed Furthermore found flour peel sunscreen potential socioenvironmental environmental agriculture end

ABSTRACT The decision tree technique in the health sciences serves to understand the correlations between the descriptions of patients and to classify accurately in various categories. The aim of the study was to analyze the accuracy of the classification of excess weight of schoolchildren through the application of a fuzzy decision tree, using a database of Itaupú, Paraná (Brazil). We used the database of a sample consisting of 5962 students (3024 female and 2938 male), with an age range between 6 to 17 years of age. The variables considered were weight, height and the Body Mass Index (BMI). To classify the anthropometric data of the students, a diffuse decision tree was used. The learning results showed a correct classification in the female sex of 2688 and in the male sex of 2471 records respectively. In relation to accuracy, 84% was determined in the male sex and 89% in the female sex. The Area under the curve showed higher values in the Fuzzy method and in both sexes (0.965-0.983), while in the classical method, they were lower (0.804-0.895). According to the calculated results it is possible to apply the fuzzy decision tree for the classification of overweight students with an acceptable accuracy, and it is presented as an alternative technique that can save time when analyzing the nutritional status, however, no other statistical calculations were made that have to do with the precision and accuracy through conventional statistical methods and compare with the technique of fuzzy trees.

RESUMEN La técnica del árbol de decisiones en las ciencias de la salud sirve para comprender las correlaciones entre las descripciones de los pacientes y para clasificar de forma precisa en diversas categorías. El objetivo del estudio fue analizar la exactitud de la clasificación del exceso de peso de escolares mediante la aplicación de un árbol de decisión difusa, utilizando una base de datos de Itaupú, Paraná (Brasil). Se utilizó la base de datos de una muestra conformada por 5962 estudiantes (3024 del sexo femenino y 2938 del sexo masculino), con un rango de edad entre los 6 a 17 años de edad. Las variables consideradas fueron peso, estatura y el Índice de Masa Corporal (IMC). Para clasificar los datos antropométricos de los escolares se utilizó un árbol de decisión difusa. Los resultados del aprendizaje mostraron una clasificación correcta en el sexo femenino de 2688 y en el sexo masculino de 2471 registros respectivamente. En relación a la exactitud, se determinó 84% en el sexo masculino y 89% en el sexo femenino. El Área Bajo la curva mostró valores más altos en el método Difuso y en ambos sexos (0.965-0.983), mientras que en el método clásico, fueron inferiores (0.804-0.895). De acuerdo a los resultados calculados es posible aplicar el árbol de decisión difusa para la clasificación de escolares con exceso de peso con una exactitud aceptable, además se presenta como una técnica alternativa que puede ahorrar tiempo a la hora de analizar el estado nutricional, sin embargo, no se realizó otros cálculos estadísticos que tengan que ver con la precisión y exactitud a través de métodos estadísticos convencionales y comparar con la técnica de árboles difusos.

Abstract BACKGROUND: encrusted pyelitis is an infectious disease that is difficult to diagnose, as well as to treat. it is characterized by urothelial incrustations in the wall of the urinary tract. CLINICAL CASE: a 75-year-old man presented with a moderate case of bilateral obstructive uropathy secondary to incrusted pyelitis and ureteral stones. after several months of triple therapy with oral antibiotic and oral and intrarenal acidifiers, the patient died due to urinary sepsis arising from intense immunologic deterioration caused by his underlying disease, albeit with a clear reduction of stone burden. DISCUSSION: encrusted pyelitis treatment is complex and long duration. the prescription of different drug combinations can significantly reduce the stone burden in these patients.

Resumen ANTECEDENTES: la pielitis incrustante es una enfermedad infecciosa, difícil de diagnosticar y tratar, caracterizada por incrustaciones uroteliales de la pared del tracto urinario. CASO CLÍNICO: hombre de 75 años de edad con síndrome mielodisplásico moderado, uropatía obstructiva bilateral secundaria a pielitis incrustante y litiasis ureteral. Después de varios meses de recibir antibióticos por vía oral, acidificantes orales e intrarrenales, el paciente falleció por sepsis urinaria e intenso deterioro inmunológico provocado por la enfermedad basal, aunque con una clara disminución de la carga litiásica. CONCLUSIONES: el tratamiento de la pielitis incrustante es complejo y prolongado. la prescripción combinada con diferentes fármacos puede disminuir de forma importante la carga litiásica en estos pacientes.

RESUMO Uma análise da geomorfodinâmica foi realizada no setor localizado entre as comunidades La Valencia e San Isidro de Heredia, através de trabalho de campo, análise de fotografías aéreas e cartografia temática.A cartografia geomorfológica contribui com a explicação genética das formas do relevo, através da combinação da expressão gráfica dos fatores estruturais, as características litológicas e a disposição tectónica das rochas com a modelagem derivada dos agentes da meteorização. A cartografia geomorfológica, além de apontar o origem das formas do relevo, deve indicar sua sequência cronológica, realizando uma diferenciação entra as formas que estão sendo construídas na atualidade e aquelas que são herdadas.

ABSTRACT An analysis of the geomorphological dynamics of the areas between the communities of Valencia and San Isidro de Heredia through field studies, analysis of aerial photographs and thematic mapping was performed. Geomorphological mapping provides the representation of the land forms a genetic explanation, combinig the graphic expression of the structural, lithological and tectonic setting of rocks with the results of modeling weathering agents.Geomorphological maps, in addition to explaining how landforms originated, should indicate their chronological sequence, especially distinguishing forms being developed at the time moment, those that are inherited.

RESUMEN Se realizó un análisis de la geomorfodinámica del sector comprendido entre las comunidades de la Valencia y San Isidro de Heredia mediante estudios de campo, análisis de fotografías aéreas y cartografía temática. La cartografía geomorfológica aporta a la representación de las formas del relieve una explicación genética, combinando la expresión gráfica de los factores estructurales, características litológicas y disposición tectónica de las rocas con los resultados del modelado de los agentes de la meteorización. Los mapas geomorfológicos, además de explicar cómo se originaron las formas del relieve, deben indicar su secuencia cronológica, distinguiendo especialmente las formas que se están elaborando en la actualidad de aquellas que son heredadas.

The purpose of this study was to find out which stereotypes prevail in future Physical Education (PE) teachers when asked about immigrant population and to see if within that stereotype, there are subtle or blatant racist attitudes, as well as egalitarian attitudes. A sample of 2524 volunteer pre-service Physical Education teachers (PPET) was used to participate in this study. A questionnaire on Racist Stereotypes in Initial Training of PE Teachers and a Subtle and Blatant Prejudice Scale were used. Descriptive, univariate and multivariate statistics were used to analyse the information gathered. The data showed PPET with a false tolerant stereotype, where the contextual variables gender and religious preference were crucial, since the boys respect girls, as well as Catholics regard non-believers or other religions, they are reflected less egalitarian stereotypes.

O objetivo deste estudo foi investigar os estereótipos que prevalecem nos futuros professores de Educação Física (EF) quando são perguntados sobre a população de imigrantes e observar se a partir deste estereótipo, existem atitudes racistas sutis, atitudes racistas explícitas, ou atitudes igualitárias. A amostra do estudo foi composta por 2524 futuros professores de educação física. Utilizou-se um questionário para avaliar os estereótipos racistas na formação inicial de professores de EF, assim como uma escala que distingue entre o prejuízo sutil e o explícito. Para análise dos dados foi empregada estatística descritiva, análise Univariada e análise Multivariada. Os resultados mostraram que futuros professores possuem um falso estereótipo de tolerância, onde as variáveis de gênero e preferência religiosa foram fundamentais, uma vez que meninos respeitaram as meninas, assim como os católicos respeitaram pessoas de outras religiões e pessoas sem religião, refletindo estereótipos menos igualitários.

El propósito de este estudio fue descubrir los estereotipos que prevalecen en los futuros profesores de Educación Física (EF) cuando se les preguntó sobre la población inmigrante y observar si dentro del estereotipo, existen actitudes racistas sutiles, actitudes racistas explicitas, o actitudes igualitarias. La muestra que participó en este estudio fue de 2524 futuros profesores de educación física. Se utilizó un cuestionario para conocer los estereotipos racistas en la formación inicial de profesores de EF, así como una escala que distingue entre el prejuicio sutil y el prejuicio manifiesto. Para analizar los datos se hizo uso de estadística descriptiva, el análisis Univariado y Multivariado. Los resultados mostraron que los futuros docentes poseen un falso estereotipo tolerante, donde las variables contextuales de género y preferencia religiosa fueron cruciales, puesto que los chicos respecto de las chicas, así como los católicos respecto a los no creyentes o de otras religiones, reflejaron estereotipos menos igualitarios.

RESUMOA espécie Dicksonia sellowiana, conhecida popularmente como xaxim, é uma samambaia natural do continente americano e encontrada no Brasil na Mata Atlântica. Em 2001 foi inserida na lista do IBAMA como espécie ameaçada de extinção em decorrência da exploração para a confecção de vasos para a jardinagem. O presente trabalho descreve o potencial antioxidante lipídico (TBARS e Sistema β-caroteno/ácido linoleico) do extrato bruto e frações obtidos através de aparato de Soxhlet de frondes de Dicksonia sellowiana, além da atividade citotóxica e hemolítica in vitro. Pelo método TBARS, todas as amostras testadas apresentaram atividade, destacando a fração acetato de etila e extrato bruto cuja atividade foi comparável ao padrão ácido ascórbico. No sistema β-caroteno/ácido linoleico, a fração acetato de etila e extrato bruto apresentaram inibição da oxidação do ácido linoleico, destaque para a fração acetato de etila que não se diferenciou estatisticamente do padrão BHT. Na avaliação da toxicidade preliminar, não fora observado atividade citotóxica e hemolítica do extrato bruto e frações nos modelos testados. Os resultados demonstram o potencial antioxidante da espécie vegetal nos modelos de inibição da oxidação lipídica sem apresentar toxicidade.

ABSTRACTThe species Dicksonia sellowiana, popularly known as tree fern, are a natural fern from American continent found in the Atlantic Forest in Brazil. In 2001 it was added to the list of IBAMA as endangered species due to its exploitation for pots craft for gardening species. This paper describes the antioxidant lipid potential (TBARS and System β-carotene / linoleic acid) of the crude extract and fractions obtained by Soxhlet apparatus of Dicksonia sellowianafronds, besides the cytotoxic and hemolytic activity in vitro. By the TBARS method, all samples tested showed activity, particularly the fraction ethyl acetate and the crude extract whose activity was comparable to standard ascorbic acid. In the system β-carotene / linoleic acid, the fraction of ethyl acetate and crude extract inhibited the oxidation of linoleic acid, especially the ethyl acetate fraction which did not differ statistically from the standard BHT. In a preliminary assessment of toxicity,cytotoxic and hemolytic activity of crude extracts and fractions in the tested models were not observed. The results of this study indicate the antioxidant potential of this plant species in models of inhibiting lipid oxidation without producing toxicity.

BACKGROUND: Pneumocystis jiroveci pneumonia is still a common cause of severe disease in HIV-infected infants <5 months of age. Despite attention to the prevention of mother-to-child transmission programme in South Africa (SA), HIV testing remains incomplete and infants are still at risk. The management of Pneumocystis pneumonia requires ventilation strategies and combination antibiotics. METHODS: A prospective but open intervention was performed on all HIV-exposed patients admitted with severe pneumonia to the paediatric intensive care unit (PICU) at Steve Biko Academic Hospital, SA, during a 3-year period from January 2009 to December 2011. All patients were treated with ampicillin, amikacin, co-trimoxazole, prednisone and intravenous gancilovir. Highly active antiretroviral therapy (HAART) was initiated in the PICU as soon as tuberculosis was excluded and HIV status confirmed with an HIV viral load (VL). Routine blood and tracheal specimens were cultured for bacteria and tested by direct fluorescent antigen testing for P jiroveci. Cytomegalovirus (CMV) VL was tested. All infants were ventilated in a standard fashion and none were oscillated. RESULTS: A total of 87 patients were admitted during the 3-year period. Of these, 29 patients were excluded from the study because they were HIV-unexposed. Ten patients died during the 3-year period. In a multivariate analysis of the presence or absence of P jiroveci, HIV VL, CD4 count, timing of HAART initiation and CMV VL, no single factor was documented to influence mortality. CONCLUSION: Mortality from Pneumocystis pneumonia continues to decrease in this PICU. No single factor is responsible and yet all therapeutic strategies contribute to survival. A national policy and guideline is urgently required.

Dasyphyllum tomentosum (Spreng.) Cabrera, açucará ou espinho-de-agulha, pertence à família Asteraceae, a qual compreende muitas espécies com propriedades terapêuticas. O objetivo deste trabalho foi avaliar extratos e frações de folhas e de cascas do caule de D. tomentosum, com relação as atividade antioxidante, citotóxica e hemolítica em testes in vitro. Todas as amostras apresentaram atividade antioxidante pelo método de inibição de DPPH, com destaque para a fração acetato de etila obtida das folhas cuja atividade foi comparável à dos padrões ácido ascórbico e rutina. Com relação à redução do complexo fosfomolibdênio, observou-se que esta mesma fração foi semelhante somente a rutina enquanto a fração obtida das cascas do caule apresentou resultado superior. Não foi observada atividade citotóxica e hemolítica frente aos modelos utilizados com os extratos e frações. Os resultados obtidos demonstram o potencial antioxidante da espécie sem apresentar toxicidade.

Dasyphyllum tomentosum (Spreng.) Cabrera, which belongs to the Asteraceae family, is well known for having many species with therapeutic properties. The aim of this study was to evaluate the extracts and fractions from the leaves and stem bark of D. tomentosum with respect to the antioxidant, cytotoxic and hemolytic activity in in vitro tests. All samples showed antioxidant activity by the DPPH inhibition method, especially the ethyl acetate fraction obtained from the leaves, whose activity was comparable to that of standard ascorbic acid and rutin. Regarding the reduction of the phosphomolybdenum complex, we noted that this same fraction was only similar to rutin and the fraction obtained from the stem bark showed superior results. There was no cytotoxicity and hemolytic activity compared to the models used in the extracts and fractions. The results demonstrate the antioxidant potential of the species without showing toxicity.

The indicators for the assessment of biological maturation are widely used in various fields. Provide relevant information for determining the rate or time of individual maturation. The use and application varies between techniques, however, all have a common goal, the classification of children and adolescents in maturation stages. In this sense, the objective of this review was to describe indicators of biological maturation and investigate the possible uses and applications within the school. We conclude that a) most studies agree that specify skeletal maturity or bone age is the most useful indicator, although predicting the peak growth rate given by Mirwald et al. (2002) is an indicator for assessing school populations transversely, and b) the assessment of maturation, regardless of the methodology can be applied in the clinic, school, sports and quality of life as a means of classifying groups working to unify children and adolescents in circunstances competition and non-sports.

Los indicadores de la valoración de la maduración biológica son ampliamente utilizados en diversas áreas. Proporcionan información relevante que permite determinar el ritmo o tiempo de maduración individual. El uso y la aplicación varía entre las técnicas, sin embargo, todos tienen un objetivo común, la clasificación de los niños y adolescentes en estadios de maduración. En este sentido, el objetivo de la presente revisión fue describir los indicadores de maduración biológica e indagar los posibles usos y aplicaciones dentro del ámbito escolar. Se concluye que a) la mayoría de los estudios coinciden en especificar que la maduración esquelética o edad ósea es el indicador más útil, aunque la predicción del pico de velocidad de crecimiento propuesta por Mirwald et al. (2002) es un indicador que permite valorar a poblaciones escolares de forma transversal y b) la valoración de la maduración, independientemente del tipo de metodología puede ser aplicada en el área clínica, la escuela, en el deporte y en la calidad de vida, como un medio de clasificación de grupos de trabajo para homogeneizar a los niños y adolescentes en circunstancias deportivas y no deportivas.

Objective. To compare the physical growth of schoolchildren to moderate altitude with reference standards proposed by Frisancho and Tracer for arm muscle area by height and Frisancho for arm muscle area by age. Method. A cross-sectional study of urban schoolchildren in the province of Arequipa (Perú). The sample was stratified by age and sex, with 473 men and 482 women ranging in age from 6 to 12 years for belonging to the education system at primary level socioeconomic status Peruvian media. Anthropometric variables were assessed weight, height, arm circumference and triceps skinfold and arm muscle area for height and age. Data were compared by Z scores according to the fraction: 100 log (percentile of the reference / percentile calculated). The differences between the sample and reference were analyzed by the paired t test with a significance of p < 0.001. Results. The values of the reference arm muscle areas in relation to height and age are higher in comparison with students of moderate altitude. Was observed 2 years behind men and women according to the comparison with age-muscle area. Similarly, using the muscle area by height 17cm lag was observed in men and 20cm in women. Conclusions. Overall, the results suggest the physical growth retardation and muscle linear, attributing this phenomenon to environmental factors such as altitude.

Objetivo. Comparar el crecimiento físico de escolares a moderada altitud con las normas de referencia propuestas por Frisancho y Tracer para el área muscular del brazo por estatura y de Frisancho para el área muscular del brazo por edad. Método. Se realizó un estudio transversal en escolares de zonas urbanas de la provincia de Arequipa (Perú). La muestra se estratificó por edad y sexo, siendo 473 hombres y 482 mujeres con un rango de edad de 6 a12 años, pertenecientes al nivel primario del sistema educativo peruano de condición socioeconómica media. Se evaluaron las variables antropométricas de peso, estatura, circunferencia del brazo y pliegue tricipital, así como el área muscular del brazo para la estatura y para la edad. Los datos se compararon a través de escores Z y de acuerdo con la fracción: 100 log (percentil de la referencia/percentil calculado). Las diferencias entre la muestra estudiada y la referencia fueron analizados por medio del test t para muestras apareadas con una significancia de p < 0,001. Resultados. Los valores de la referencia de las áreas musculares del brazo en relación a la estatura y edad son superiores en comparación con los escolares de zonas con moderada altitud. Se observó 2 años de retraso en hombres y mujeres de acuerdo a la comparación con el área muscular por edad. Del mismo modo, utilizando el área muscular por estatura se verificó un atraso de 17cm en los hombres y de 20cm en las mujeres. Conclusión. En general, los resultados sugieren retraso sobre el crecimiento físico lineal y muscular, atribuyéndose este fenómeno a factores medio-ambientales como la altitud.

Background Emotional factors may lead to cognitive impairment that can adversely affect the capacity of patients to reason, and thereby, limit their participation in decision taking. Purposes: To analyze critical patient aptitude for decision taking, and to identify variables that may influence competence. Design: An observational descriptive study was carried out. Setting: Intensive care unit. Patients: Participants were 29 critically ill patients. Main variables: Social, demographic and psychological variables were analyzed. Functional capacities and psychological reactions during stay in the ICU were assessed. Results: The patients are of the firm opinion that they should have the last word in the taking of decisions; they prefer bad news to be given by the physician; and feel that the presence of a psychologist would make the process easier. Failure on the part of the professional to answer their questions is perceived as the greatest stress factor. Increased depression results in lesser cognitive capacity, and for patients with impaired cognitive capacity, participation in the decision taking process constitutes a burden. The variables anxiety and depression are significantly related to decision taking capacity.

Introducción: Factores emocionales pueden condicionar alteraciones cognitivas que bloqueen la habilidad del paciente para razonar, limitando su participación en la toma de decisiones. Objetivos: Evaluar la disposición del paciente crítico para tomar decisiones e identificar qué variables pueden influir en su competencia. Diseño: Estudio observacional descriptivo. Ámbito: Unidad de cuidados. Pacientes: 29 pacientes críticos. Variables: Se analizaron variables sociodemográficas y psicológicas. Se evaluó la capacidad funcional y la reacción psicológica durante la estancia en UCI. Resultados: Muestran que los pacientes están totalmente de acuerdo en que la última palabra a la hora de tomar decisiones corresponde a ellos mismos, prefieren que una mala noticia sea trasmitida por el médico y dicen que la presencia del psicólogo facilitaría el proceso. Que los profesionales no respondan a sus preguntas es el factor de mayor estrés. A mayor nivel de depresión resulta una menor capacidad cognitiva, y para los pacientes con menor capacidad cognitiva, participar en la toma de decisiones supone una sobrecarga. Las variables ansiedad y depresión se relacionan significativamente con la capacidad para tomar decisiones.

Objective: Laparoscopic adenomectomy 150 is a minimally invasive alternative to open surgery in large prostates. Our aim is to discuss our series of 59 patients treated by means of laparoscopic adenomectomy with precise vascular control. Materials and methods: Between June 2003 and June 2006, a total of 59 patients with a mean age of 65.5years (51 to 82), underwent laparoscopic extraperitoneal adenomectomy. All the patients had a history of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). The mean International Prostate Symptom Score (IPSS) was 20 points (16-22). The information was collected prospectively in a database. The analysis was performed subsequently. Results: All 59 adenomas were completely removed laparoscopically without conversion to open surgery. The mean preoperative prostate volume by ultrasound was 108.5 cc (75-150). The average operating time was 123 minutes (90-180). The mean loss of blood was 415ml (50-1500) and 4 patients (14.8%) required a blood transfusion. Two (7.4%) of the patients presented perioperative complications. The mean hospital stay and the bladder catheterization time were 3.5 (2-7) and 4.2 (3-7) days respectively. Conclusions: Laparoscopic extraperitoneal simple prostatectomy is an effective procedure for the treatment of large prostatic adenomas. There seems to be less perioperative morbidity and, in our experience, this technique seems to be feasible and reproducible; however, its learning curve is a complicated matter to deal with.

Objetivo: La adenomectomía laparoscópica es una alternativa mínimamente invasiva a la cirugía abierta en próstatas de gran volumen. Nuestro objetivo es dar a conocer nuestra serie de 59 pacientes tratados mediante adenomectomía laparoscópica con control vascular preciso. Material y métodos: Entre junio de 2003 y junio de 2006 un total de 59 pacientes con una edad promedio de 65,5 años (51 a 82) fueron sometidos a adenomectomía laparoscópica extraperitoneal. Todos los pacientes tenían un historial de síntomas del tracto urinario inferior (STUI) y de hiperplasia benigna de próstata (HPB). La mediana del International Prostate Symptom Score (IPSS) fue de 20 puntos (16-22). La información fue recogida de forma prospectiva en una base de datos. El análisis fue realizado a posteriori. Resultados: Todos los 59 adenomas fueron extirpados en su totalidad por vía laparoscópica sin conversión a cirugía abierta. La mediana de volumen prostático preoperatorio medida por ultrasonidos fue de 108,5 cc (75-150). El tiempo operatorio promedio fue de 123 minutos (90-180). La pérdida de sangre promedio fue 415ml (50-1500) y 4 pacientes (14,8%) requirieron transfusión de sangre. Dos (7,4%) de los pacientes presentaron complicaciones perioperatorias. La mediana de estancia hospitalaria y el tiempo de sonda vesical fueron de 3,5 (2-7) y 4,2 (3-7) días respectivamente. Conclusiones: La prostatectomía laparoscópica simple extraperitoneal es un procedimiento efectivo para el tratamiento de grandes adenomas prostáticos. Parece haber menos morbilidad perioperatoria y en nuestra experiencia esta técnica parece factible y reproducible; sin embargo, su curva de aprendizaje es un tema complicado de abordar.

Introduction: We describe the technique and present the preliminary results of the laparoscopic radical cystectomy technique with the extracorporeal creation of a "y" shaped ileal orthotopic neobladder using non-absorbable mechanical suture (Fontana). Materials and method: We describe the technique step by step and we present a series of 15 patients that underwent this surgery between November 2005 and August 2009, with special emphasis on the duration of the surgery, urinary diversion time, intraoperative and postoperative complications, daytime and night time continence and the frequency of postoperative micturition. Results: The mean follow-up of the series was 24 months (6-32). The mean duration of surgery was 280 (range 210-345) minutes and the mean urinary diversion time was 54.5 (range 40-75) minutes. There were no intraoperative complications and the average hospitalization time was 7 (range 5-15) days. During the follow-up, there were 5 late postoperative complications, 2 cases of urinary infection with good response to antibiotic treatment and 3 uretero-neovesical anastomosis strictures, which were treated with percutaneous balloon dilation, with a good functional result. No lithiasis was found in the neobladder. Complete daytime continence was obtained in 13/14 patients (92.9%) and complete night time continence in 6/14 (42.9%). One patient (6.7%) required clean intermittent self-catheterization as the patient did not micturate spontaneously. Conclusions: The creation of a "Y" shaped ileal orthotopic neobladder using non-absorbable mechanical suture is a feasible, fast and safe technique and it provides promising functional results. Further follow-up is required to determine its long-term results.

Introducción: se describe la técnica y se presentan los resultados preliminares de la técnica de cistectomía radical laparoscópica con confección extracorpórea de neovejiga ortotópica ileal en forma de "Y", usando una sutura mecánica no reabsorbible (Fontana). Material y método: se describe paso a paso la técnica y se presenta una serie de 15 pacientes sometidos a esta cirugía entre noviembre de 2005 y agosto de 2009, con especial énfasis en el tiempo de cirugía, tiempo de derivación urinaria, las complicaciones intraoperatorias y postoperatorias, la continencia diurna y nocturna y la frecuencia miccional postoperatoria. Resultados: la mediana de seguimiento de la serie es de 24 meses (6-32). El tiempo quirúrgico medio fue 280 (rango: 210-345) minutos y el tiempo medio de la derivación urinaria fue 54,5 (rango: 40-75) minutos. No se presentaron complicaciones intraoperatorias y el tiempo promedio de hospitalización fue de 7 días (rango: 5-15). Durante el seguimiento se presentaron 5 complicaciones postoperatorias tardías, dos cuadros de infección urinaria con buena respuesta al tratamiento antibiótico y tres estenosis de la anastomosis uretero-neovesical, que se han manejado con una dilatación percutánea con balón con un buen resultado funcional. No se han encontrado litiasis en la neovejiga. Se obtuvo continencia diurna completa en 13 de 14 pacientes (92,9%) y nocturna completa en 6 de 14 (42,9%). Un paciente (6,7%) precisa autosondaje limpio intermitente por no presentar micción espontánea. Conclusiones: la neovejiga ortotópica ileal en forma de "Y" usando una sutura mecánica no reabsorbible es una técnica factible, rápida, segura y que permite resultados funcionales prometedores. Se necesita mayor seguimiento para determinar sus resultados a largo plazo.