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RESUMENNEOVEJIGA ILEAL CON DOBLE CHIMENEA. ANASTOMOSIS URETEROINTESTINAL La cistoprostatectomía radical es el tratamiento de elección para el cáncer vesical infiltrante. En los últimos años las indicaciones de sustitución vesical se han ampliado debido a las ventajas que aportan sobre otros tipos de derivaciones siendo la neovejiga ileal descrita por Hautmann una de las más utilizadas. Posteriormente se han descrito diversas modificaciones de la técnica original como la utilización de un segmento de asa sin detubulizar a modo de chimenea a la cual se anastomosan los uréteres. Presentamos una variante técnica de la neovejiga de Hautmann utilizando dos "chimeneas" anastomosando cada uréter a la luz previamente abierta de cada asa espatulando el uréter a modo de "palo de golf" para adaptar los calibres. Entre las ventajas de este tipo de anastomosis destacan la utilización de segmentos ureterales más cortos adaptando la longitud del asa lo que posibilita una anastomosis sin tensión y minimiza la isquemia disminuyendo por tanto la aparición de fístulas y estenosis. No precisa la realización de enterotomías adicionales y se facilita el acceso a cada anastomosis por separado en caso de necesidad de reintervención.Palabras clave: Cistoprostatectomía. Neovejiga ileal. Anastomosis ureteroileal. ABSTRACTILEAL NEOBLADDER WITH DOUBLE CHIMNEY. URETEROINTESTINAL ANASTOMOSIS Radical cystoprostatectomy is accepted as the standard treatment for muscle-invasive bladder cancer. During last years the indications for orthotopic neobladders have increased due to their advantages over other kind of diversions. Hautmann neobladder is one of the most commonly used. Several modifications have been later described. For example, after perform the W-shape pouch ureters can be anastomosed to a not-detubularized bowel segment (chimney modification).Here is described a modification of the Hautmann neobladder with two chimneys. Each ureter is spatulated in a golf club manner and anastomosed to the open end of each bowel loop. This kind of anastomosis provides several advantages. It is possible to use shorter ureteral segments by increasing the length of bowel used. It allows an anastomosis without tension, and less ischemia, so the risk of stenosis and fistula is decreased. It is not necessary to perform additional enterothomies and in case of reintervention it is easier to access each anastomosis without damaging the other one.

The pharmaceutical care concept has been popular in the world during past decades, but it did not reach well to its maturity in some countries, so the investigation on barriers to the implementation of the pharmaceutical care in these countries would be great of interest. objeCtives: The aim of the study was to identify and prioritize barriers to the provision of pharmaceutical care in Iranian community pharmacies based on Tehran community pharmacists' perceptions. Setting The present study was conducted with participation of pharmacists working in community pharmacies settled in Tehran, the capital city of Iran. Methods: A cross-sectional descriptive study was performed using an anonymous questionnaire between August and November 2013. 505 community pharmacists expressed their perceptions on items by a 5-point Likert-type scale. Besides descriptive analysis, data was also analyzed through structural equation modeling. Main outcome measured was the importance perceived by community pharmacists in the case of 5 area including resources, attitude and vision, education and training, skills, regulatory and environmental issues. Results: Five major dimensions included in the survey instrument were confirmed by confirmatory factor analysis. According to the model developed based on pharmacists' opinions, lack of pharmacists' skills and lack of appropriate regulation and environment are the two most important barriers of the provision of pharmaceutical care, and the least important is lack of resources. ConClusions: Findings of the present study showed that importance of various barriers vary from country to country based on the pharmacists' perceptions, and corrective actions should be made accordingly. PHP131 costs and effectiveness of tHe mediguide tecHnology in tHe conditions of tHe czecH rePuBlicJurickova I. , objeCtives: MediGuide technology is designed to monitor the position of diagnostic and therapeutic catheters equipped with a sensor MediGuide and navigation in vascular or cardiac intervention in the environment of electro-physiological laboratory. MediGuide compared to conventional technology, offers the 3D display on the live fluoroscopy or recorded background, radiation burden reduction, fluoroscopy time and total time performance. The aim of this thesis is to analyze the clinical and cost effectiveness of new technologies MediGuide in the Czech Republic. Results of the analysis are being compared to the studies of the German Cardiac where technology is positively evaluated. Methods: The evaluation method is cost-effectiveness analysis, which compares technology system MediGuide to a comparator angiography Siemens Artis Zee. Value of the effect was determined by TOPSIS in which they were entered weight values obtained by Saaty method of pair comparison by group of experts. The sum of direct costs includes costs associated with the operation of both technologies. Calculated values of costs and effects were achieved in incremental ICER assessment ratio, fixing the amount of costs per unit of effect. Results:...

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independent prognosticator of actual warm ischemic time but not for functional warm ischemic time. Utilization of selected DCD donors with warm ischemic times > 2 hr should be considered.