Development of an ultrasound-guided technique for pudendal nerve block in cat cadavers.

The objective of this prospective experimental cadaveric study was to develop an ultrasound-guided technique to perform an anaesthetic pudendal nerve block in male cats. Fifteen fresh cadavers were used for this trial. A detailed anatomical dissection was performed on one cat in order to scrutinise the pudendal nerve and its ramifications. In a second step, the cadavers of six cats were used to test three different ultrasonographic approaches to the pudendal nerve: the deep dorso-lateral, the superficial dorso-lateral and the median transperineal. Although none of the approaches allowed direct ultrasonographical identification of the pudendal nerve branches, the deep dorso-lateral was found to be the most advantageous one in terms of practicability and ability to identify useful and reliable landmarks. Based on these findings, the deep dorso-lateral approach was selected as technique of choice for tracer injections (0.1 ml 1% methylene blue injected bilaterally) in six cat cadavers distinct from those used for the ultrasonographical study. Anatomical dissection revealed a homogeneous spread of the tracer around the pudendal nerve sensory branches in all six cadavers. Finally, computed tomography was performed in two additional cadavers after injection of 0.3 ml/kg (0.15 ml/kg per each injection sites, left and right) contrast medium through the deep dorso-lateral approach in order to obtain a model of volume distribution applicable to local anaesthetics. Our findings in cat cadavers indicate that ultrasound-guided pudendal nerve block is feasible and could be proposed to provide peri-operative analgesia in clinical patients undergoing perineal urethrostomy.

Current aspects and future prospects of total anorectal reconstruction - a critical and comprehensive review of the literature

PURPOSE: Many rectal cancer patients undergo abdominoperineal excision worldwide every year. Various procedures to restore perineal (pseudo-) continence, referred to as total anorectal reconstruction, have been proposed. The best technique, however, has not yet been defined. In this study, the different reconstruction techniques with regard to morbidity, functional outcome and quality of life were analysed. Technical and timing issues (i.e. whether the definitive procedure should be performed synchronously or be delayed), oncological safety, economical aspects as well as possible future improvements are further discussed. METHODS: A MEDLINE and EMBASE search was conducted to identify the pertinent multilingual literature between 1989 and 2013. All publications meeting the defined inclusion/exclusion criteria were eligible for analysis. RESULTS: Dynamic graciloplasty, artificial bowel sphincter, circular smooth muscle cuff or gluteoplasty result in median resting and squeezing neo-anal pressures that equate to the measurements found in incontinent patients. However, quality of life was generally stated to be good by patients who had undergone the procedures, despite imperfect continence, faecal evacuation problems and a considerable associated morbidity. Many patients developed an alternative perception for the urge to defecate that decisively improved functional outcome. Theoretical calculations suggested cost-effectiveness of total anorectal reconstruction compared well to life with a permanent colostomy. CONCLUSIONS: Many patients would be highly motivated to have their abdominal replaced by a functional perineal colostomy. Given the considerable morbidity and questionable functional outcome of current reconstruction technique improvements are required. Tissue engineering might be an option to design an anatomically and physiologically matured, and customised continence organ.

El Desarrollo Endógeno Sustentable como interfaz para implementar el Vivir Bien en la gestión pública Boliviana

Al leer, entender, sentir y reflexionar el presente libro, percibo esa búsqueda de complementariedad de hermanos académicos universitarios que creen en el proceso de cambio y aportan desde sus experiencias a la reconstrucción del vivir bien, pues queremos valorar nuestra historia, nuestra música, nuestra vestimenta, nuestra cultura, nuestro idioma, nuestros recursos naturales para volver a lo que fuimos. Para esto es necesario la participación y el diálogo de saberes entre nuestros pueblos indígenas originarios con hermanos profesionales aymaras, quechuas, guaraníes, mestizos surgidos de nuestras universidades. Los conocimientos que han surgido de la universidades, llamados por los autores, “conocimiento científico occidental moderno”, en la actualidad es el conocimiento hegemónico en la gestión pública que no siempre encaja con el pensasiento (pensar – sentir) de nuestros pueblos. Para mí es importante y sorprendente que desde las universidades surjan profesionales que busquen puentes entre los saberes ancestrales de nuestros pueblos y los conocimientos que han venido de Europa, EEUU u otros territorios y que hoy son impartidos en nuestros centros educativos en todos los niveles. Estos puentes a través del diálogo, deben permitir una gestión pública intra e intercultural para vivir bien, lo que implica una búsqueda de alternativas a las maneras de gobernar, a las maneras de administrar y a la concepción de un nuevo Estado, orientado a la construcción de una nueva vida. Esto implica, experimentar nuevos proyectos con nuestra cosmobiovisión ancestral y los aportes de los conocimientos de la modernidad, que respeten la vida y los derechos de la madre tierra. Los fundamentos y las experiencias que exponen nuestros autores despiden sentimientos de complementariedad, siendo fundamentales para este proceso de cambio que preside nuestro hermano presidente Evo Morales Ayma.