Javier Nuño

Total fecal incontinence-a new method of gluteus maximus transposition: Preliminary results and report of previous experience with similar procedures

Since 1986, different procedures of gluteus maximus transposition have been performed, by one of the authors, in 10 patients with total anal incontinence not amenable to sphincter repair, due to congenital anomalies (four), sphincteric denervation (three) or after severe trauma (three). Variable degrees of long-lasting fecal control were obtained in all but one patient, with great improvement in six. Difficulties for achieving a closed anus without muscular tension of the neosphincter, together with the morbidity associated with anal wound infection, determined the reasons for the successive use of different techniques (Biström, Hentz, Schoamaker) until the authors, in 1990, designed a new procedure (Devesa). Although the reported experience with this technique described here is limited to only four patients, our impression is that the method is easier, has less morbidity, and achieves better short-term functional results, derived from a thick, tension-free neosphincter.

Raman-Assisted Brillouin Distributed Temperature Sensor Over 100 km Featuring 2 m Resolution and 1.2

Raman assistance in distributed sensors based on Brillouin optical time-domain analysis can significantly extend the measurement distance. In this paper, we have developed a 2 m resolution long-range Brillouin distributed sensor that reaches 100 km using first-order Raman assistance. The estimated uncertainty in temperature discrimination is 1.2°C, even for the position of worst contrast. The parameters used in the experiment are supported by a simple analytical model of the required values, considering the main limitations of the setup.

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PURPOSE: This study describes our clinical experience with adynamic bilateral gluteoplasty in 20 patients with total fecal incontinence, in whom a sphincter repair had failed (n=17) or was nonviable. METHODS: Between 1986 and 1995, 12 women and 8 men ranging in age from 15 to 58 (mean, 37) years underwent different techniques of adynamic gluteoplasty. The indications for the operation were congenital anomalies, denervation, or sphincter destruction. Postoperative evaluation was clinical (Pescatori grading; self-evaluation) and manometric. RESULTS: Morbidity was only related to wound infection (n=7) requiring late reoperations for neosphincter repair (n=5), anal stenosis (n=2), and incisional hernia after colostomy closure (n= 1). Two other patients with no complications also had further surgery for tightening of the neosphincter; they had a successful outcome. Of the 17 evaluable patients, 9 (53 percent) achieved normal control or were graded as Pescatori A-1, A-2, B-1, or C-1, 1 (6 percent) as Pescatori C-2, and 7 (41 percent) as Pescatori C-3. Six patients (35 percent) judged their results as excellent, three (18 percent) as good, one (6 percent) as fair, and seven (41 percent) as bad. Eight patients are able to retain 200 ml of water instilled into the rectum for between five minutes and two hours. For the nine patients with better results, the mean ± standard deviation of the differences between postgluteoplasty and pregluteoplasty anal pressures were 40±25 mmHg (resting pressure) and 122±85 mmHg (squeeze pressure). These findings demonstrate a tonic and voluntary activity of the plasty. The authors technique has less morbidity, and excellent or good results were achieved in 67 percent of the patients. Failures were attributable to suture disruption (n=4), poor muscular contraction (n=2), and intractable constipation (n=1). CONCLUSIONS: Adynamic gluteoplasty is efficient for achieving good or very good continence status in a higher proportion of patients than with other adynamic muscle transfer procedures.

C Uncertainty

We numerically investigate relative intensity-noise transfer from a noisy pump to the generated Stokes component in random distributed feedback ultralong Raman fiber lasers. Results show transfer levels comparable to those in distributed Raman amplification and cavity-based ultralong Raman fiber lasers, but with some unique spectral features.

Bilateral gluteoplasty for fecal incontinence.

Liver transplantation is being evaluated as a therapeutic option for human immunodeficiency virus (HIV)‐infected patients with end‐stage liver disease, but experience is still scarce. We describe the outcome of 4 HIV‐infected patients who underwent liver transplantation in our hospital between July 2002 and April 2003. HIV‐infected liver transplant recipients meet the same standard criteria for transplantation as do HIV‐negative candidates. In addition, HIV infected persons are required to have a CD4 T‐cell count greater than 100/mL (CD4 T‐cells are targets for HIV infection). Immunosuppressive regimens, perioperative surgical prophylaxis, and prophylaxis for opportunistic infections are standard in the Liver Transplantation Unit in our hospital. Four patients, including 3 former intravenous drug users, received a liver transplant (2 from deceased donors and 2 from living donors), with a median follow‐up of 510 days. Three patients (75%) are alive, with 1 death occurring 17 months posttransplantation in a patient who developed fibrosing cholestatic hepatitis. Rejection occurred in 1 patient, and was managed with no complications. Hepatitis C virus (HCV) recurrence occurred in 3 patients. HIV‐infection has remained under control with antiretroviral treatment. A combination of 3 nucleoside analogs was used in 3 patients, with no need for drug adjustments. No opportunistic infections or other significant infectious complications developed. In conclusion, orthotopic liver transplantation seems a safe therapeutic option in the short term for HIV‐infected persons with end stage liver disease, including patients with a history of drug abuse. If indicated, an antiretroviral regimen consisting of 3 nucleosides could be used to avoid interactions with immunosuppressive drugs. (Liver Transpl 2005;11:76–81.)

RIN transfer in random distributed feedback fiber lasers.

The cases of four liver transplant recipients who developed invasive candidiasis (2 cholangitis, 1 perihepatic abscess, 1 candidemia) due to azole-resistantCandida glabrata are reported. Three patients were receiving azolic compounds (2 itraconazole, 1 fluconazole) when the infection was diagnosed. All four patients received fluconazole as intestinal decontamination during the first three weeks post transplantation. The infections occurred two months after transplantation in all patients, and in one patientCandida infection was the direct cause of death. Infection of the biliary tree was the origin of candidiasis in three patients; the fourth patient developed neutropenic-related candidemia. Fluconazole MICs exceeded 16 μg/ml in all cases; itraconazole MICs were 16, 2, 1, and 2 μg/ml, respectively. The potential role ofCandida species other thanalbicans in these patients after administration of azole agents is discussed.

Liver Transplantation in HIV-infected recipients

We propose and apply a theoretical description of a Raman amplifier based on the vector model of randomly birefringent fibers to the characterization of Raman polarizers. The Raman polarizer is a special type of Raman amplifier with the property of producing a highly repolarized beam when fed by relatively weak and unpolarized light.

Selection ofCandida glabrata strains with reduced susceptibility to azoles in four liver transplant patients with invasive candidiasis

Objectives: the incidence of hepatic hydatidosis has remark ably decreased in the last years due to the preventive measures adopted to stop the transmission of the parasite. However, surgery carries on being the treatment of choice, although the surgical pro cedure is still a matter of controversy. The aim of the study was to evaluate the results obtained with the treatment of this condition after two decades according to surgical procedure type. Material and methods: from 1983 to 2005, 372 patients were operated on for hepatic hydatidic cyst in Hospital Ramon y Cajal. Radical surgery was performed for 162 (43.5%) and con servative surgery for 210 (56.5%). Results: average postoperative hospital stay (8.65 vs. 14.9 days), morbidity (13.3 vs. 31.4%, p < 0.001), and mortality (0 vs. 3.8%, p < 0.01) were lower in the radical surgery group. Recur rence rate was 1.85% after radical surgery versus 11.9% in the conservative surgery group (p < 0.0001). Conclusion: radical surgery is associated with lower morbidi ty, mortality, postoperative hospital stay, and recurrence rates, and represents the treatment of choice for hepatic hydatidosis. However, its indication must depend on the patient characteris tics, cyst anatomy, and surgical team experience.

Theory of fiber optic Raman polarizers

The theory of two counter-propagating polarized beams interacting in a randomly birefringent fiber via the Kerr and Raman effects is developed and applied to the quantitative description of Raman polarizers in the undepleted regime. Here Raman polarizers, first reported by Martinelli, are understood as Raman amplifiers operating in the regime in which an initially weak unpolarized beam is converted into an amplified fully polarized beam towards the fiber output. Three parameters are selected for the characterization of a Raman polarizer: the degree of polarization of the outcoming beam, its state of polarization, and its gain. All of these parameters represent quantities that are averaged over all random polarization states of the initially unpolarized signal beam. The presented theory is computer friendly and applicable to virtually all practically relevant situations, including the case of co-propagating beams, and in particular to the undepleted as well as the depleted regimes of the Raman polarizer.

Hidatidosis hepática: Cirugía radical vs. no radical: 22 años de experiencia

BACKGROUND There is an increasing interest in the role of combined therapy to achieve long-term survival for patients with resectable esophageal neoplasms. Surgery provides excellent palliation with relatively low morbidity and mortality rates, but cure remains elusive. MATERIAL AND METHODS From January 1988 to January 1998, a total of 137 patients met eligibility criteria for a combined multimodal therapy, prospective, nonrandomized protocol of induction chemoradiation therapy followed by surgical resection, based on radiological and endoscopic assessment of the extension (all patients were initially considered to be at clinical stages I to III, locoregional). Consequently, patients with high grade Barretts dysplasia or any squamous carcinoma in situ (stage 0) and those with distant metastatic disease (stage IV) were excluded. Among this group, 48 operable patients with biopsy-proven esophageal cancer finally entered and completed the protocol and are the sample of the present study. Multivariate logistic regression models were used to identify risk factors for death or recurrence. Actuarial survival was calculated since the beginning of the induction protocol by the Kaplan-Meier method, and comparisons between groups were made by the log-rank test. RESULTS Mean age was 61.6 (range 45 to 71), and 72.9% were male. The majority of the tumors (70.8%) were located at the lower third/cardia and as many as 18.8% were adenocarcinoma. After a mean of 7.5 weeks (range 5 to 12) after the completion of the induction phase, 68.7% underwent a transthoracic esophagectomy and 31.3% a transhiatal esophagectomy. The in-hospital mortality rate was 10.4% (5 patients). A complete response (no evidence of tumor within the specimen: pT0) was achieved in 25% (12 patients). After a mean follow-up of 20.2 months, mean survival for the entire group was 18.2 months (95% confidence interval 14 to 22). At the end of the study, 25% (12) remained alive. Actuarial survival rates at 12, 23, and 37 months were 56.2%, 36.9%, and 21.9%, respectively. CONCLUSIONS Esophageal resection after induction therapy seems to be related to a slightly higher mortality rate compared with historical series, and for this reason, neoadjuvant therapy must be considered still experimental. However, no statistical significant difference in survival is showed in those cases with complete pathological response (pT0). Factors influencing survival are recurrence and age. Surgery alone remains the standard therapy for esophageal cancer.