[Palpable undescended testicle: Surgical treatment by pre-scrotal incision Bianchi's Technique]. / Testículo no descendido palpable. Tratamiento quirúrgico mediante incisión para-escrotal: "Técnica de Bianchi".

OBJECTIVE: To present a retrospective, descriptive and observational study performed on a group of patients diagnosed with palpable undescended testicle (PUT) and surgically treated by pre-scrotal access, the "Bianchi technique". METHODS: The sample consists of a group of patients from 6 to 168 months old, diagnosed with palpable undescended testicle and treated by orchidopexy through pre-scrotal access Bianchi type (4), from January 2008 to June 2015 by the Pediatric Urology Equipment of Malaga, where the authors belong. To be part of the sample, the patients must meet the following requirements: male, diagnosis PUT, older than 6 months old and a minimum of 6 months of postoperative follow. RESULTS: The sample is comprised of 200 testicles and 157 patients diagnosed with PUT, aged between 6 and 168 months old and treated by the same main surgeons. In a 72.62% of the patients the anomaly was unilateral. From the 200 testicles intervened, a 51.5% had PUT on the right side. Localization of the undescended testis was in the inguinal canal in a 64.5% of cases, 22.5% in the superficial inguinal canal and a 13% in the deep one. There weren't significant complications but in 4.5% of the cases there were minor complications that did not require treatment (cutaneous scrotal hematoma, 2.5%; scrotal skin edema, 1.5%, and partial dehiscence, 0.5%). Regarding the state of the scar, in 15.5% it's not visible, in 16% excellent, very good in 12.5% and only 1% had a bit of an hypertrophic aspect. CONCLUSIONS: This is a easy technique, which presents good surgical results, with minimum surgical complications, its short, medium and long term results are excellent and with a great aesthetic appearence.

Testículo no descendido palpable. Tratamiento quirúrgico mediante incisión para-escrotal: 'Técnica de Bianchi' / Palpable undescended testicle: Surgical treatment by pre-scrotal incision Bianchi's Technique

OBJETIVO: Es presentar un estudio retrospectivo, descriptivo y observacional realizado sobre un grupo de pacientes diagnosticados de testículo no descendido palpable (TNDP) y tratados quirúrgicamente mediante la incisión para-escrotal, técnica 'Bianchi'. MÉTODOS: La muestra está formada por un grupo de pacientes de entre 6 y 168 meses de edad, diagnosticados de testículo no descendido palpable y tratados mediante orquidopexia a través de incisión para-escrotal tipo Bianchi (4), desde enero de 2008 a junio de 2015 por el Equipo de Urología Pediátrica de Málaga, al que los autores pertenecen. Para formar parte de la muestra los pacientes debían de cumplir los siguientes criterios: sexo masculino, diagnóstico de TNDP, edad mayor de 6 meses y tiempo mínimo de seguimiento postoperatorio de 6 meses. RESULTADOS: La muestra la componen 200 testículos y 157 pacientes diagnosticados de TNDP, con edades comprendidas entre los 6 y 168 meses y tratados por los mismos cirujanos principales. En un 72,62% de los pacientes la anomalía fue unilateral. De los 200 testículos intervenidos, un 51,5% presentaba el TNDP en el lado derecho. Localizándose el teste no descendido en un 64,5% de los casos en el conducto inguinal, un 22,5% en el conducto inguinal superficial y un 13% en el profundo. No hubo complicaciones significativas si bien se registraron un 4,5% de complicaciones leves que no requirieron tratamiento (hematoma cutáneo escrotal, 2,5%; edema cutáneo escrotal, 1,5% y dehiscencia cutánea parcial, 0,5%). Con respecto al estado de la cicatriz, en un 15,5% no se visualizaba, 16% excelente, muy bien 12,5% y sólo en 1% presentaron un aspecto algo hipertrófico. CONCLUSIONES: Es una técnica de sencilla ejecución y fácilmente reproducible, que presenta buenos resultados, mínimas complicaciones quirúrgicas. Sus resultados a medio y largo plazo son excelentes y con magnífico aspecto estético

OBJECTIVE: To present a retrospective, descriptive and observational study performed on a group of patients diagnosed with palpable undescended testicle (PUT) and surgically treated by pre-scrotal access, the 'Bianchi technique'. METHODS: The sample consists of a group of patients from 6 to 168 months old, diagnosed with palpable undescended testicle and treated by orchidopexy through pre-scrotal access Bianchi type (4), from January 2008 to June 2015 by the Pediatric Urology Equipment of Malaga, where the authors belong. To be part of the sample, the patients must meet the following requirements: male, diagnosis PUT, older than 6 months old and a minimum of 6 months of postoperative follow. RESULTS: The sample is comprised of 200 testicles and 157 patients diagnosed with PUT, aged between 6 and 168 months old and treated by the same main surgeons. In a 72.62% of the patients the anomaly was unilateral. From the 200 testicles intervened, a 51.5% had PUT on the right side. Localization of the undescended testis was in the inguinal canal in a 64.5% of cases, 22.5% in the superficial inguinal canal and a 13% in the deep one. There weren't significant complications but in 4.5% of the cases there were minor complications that did not require treatment (cutaneous scrotal hematoma, 2.5%; scrotal skin edema, 1.5%, and partial dehiscence, 0.5%). Regarding the state of the scar, in 15.5% it's not visible, in 16% excellent, very good in 12.5% and only 1% had a bit of an hypertrophic aspect. CONCLUSIONS: This is a easy technique, which presents good surgical results, with minimum surgical complications, its short, medium and long term results are excellent and with a great aesthetic appearance

Diagnosis and cause of death in a neonatal intensive care unit--how important is autopsy?

OBJECTIVES: To characterize mortality in a tertiary referral Neonatal Intensive Care Unit (NICU) in Portugal and evaluate the concordance between ante-mortem and post-mortem diagnoses. METHODS: Retrospective review of the clinical and pathological records of infants who died in five consecutive years was done. Pathological findings and clinical diagnoses were compared and classified according to general concordance and to modified Goldman classification. RESULTS: During the referred period, 1938 patients were admitted to the NICU, with a mortality rate of 5.7% (110 patients). The median of age at death was 10.5 days and the most frequent causes of death were congenital malformations and prematurity with its complications. Autopsy was performed in 53 patients resulting in a 48.2% overall autopsy rate. There was complete agreement between pathological and clinical diagnoses in 18 cases (34%) and additional findings were identified in 22 cases; in 13 cases (24.5%), the diagnosis was revised or established by pathology. Five autopsies revealed information relevant for genetic counseling. CONCLUSION: Despite the high agreement rate between clinical and pathological diagnoses, autopsy frequently added important data, including several cases in which it established the diagnosis or provided information relevant for parental counseling regarding future pregnancies.

Prospective validation of a novel strategy for assessing risk of significant hyperbilirubinemia.

OBJECTIVE: Our aim was to validate a strategy for assessing the risk of significant hyperbilirubinemia in newborns with gestational ages of ≥35 weeks by combining predischarge bilirubin percentile data with gestational age data, for a European, predominantly white population. METHODS: We conducted a prospective cohort study with 463 newborns with gestational ages of ≥35 weeks who were admitted to the well-infant nursery. Total bilirubin levels were measured daily until discharge and once after discharge, between the third and eighth days of life, by using a Bilicheck device (Respironics, Murrysville, PA). The values obtained (<52 hours) were plotted on an hour-specific bilirubin nomogram to determine the infant's bilirubin percentile, expressed as a risk zone. Patients were assigned to 1 of 3 risk groups (very low, low, or high) on the basis of a combination of risk zone and gestational age data and were monitored prospectively for the development of significant hyperbilirubinemia. The 95% confidence interval (CI) for the prevalence of significant hyperbilirubinemia was estimated with the binomial distribution method. RESULTS: Forty-four infants (11%) developed significant neonatal hyperbilirubinemia. The risks of developing significant hyperbilirubinemia were 1.3% (95% CI: 0.2%-3.7%) for the very low risk group (n = 230 [58.1%]), 3.4% (95% CI: 0.7%-9.8%) for the low risk group (n = 86 [21.7%]), and 47.50% (95% CI: 36.2%-59.0%) for the high risk group (n = 80 [20.20%]). CONCLUSIONS: The proposed strategy, based on predischarge bilirubin level and gestational age data, was a valid method for significant hyperbilirubinemia risk assessment in our population.

Prognosis of COPD patients requiring frequent hospitalization: role of airway infection.

RATIONALE: A subgroup of patients with chronic obstructive pulmonary disease require frequent hospitalization because of exacerbations of the disease. We hypothesized that airway infection by non-usual pathogens is a major factor driving hospitalization needs in these patients. OBJECTIVES: 1) To describe the clinical and functional characteristics of a cohort of COPD patients requiring > or =2 hospitalizations per year; 2) to determine prospectively their microbiological pattern during exacerbations; and, 3) to analyze the prognostic value of several clinical, functional and microbiological variables with respect to hospitalizations and mortality. METHODS: Open cohort study of 116 COPD patients who had been hospitalized at least twice during the last 12 months. Patients were followed for an average of 21 months. MEASUREMENTS AND MAIN RESULTS: Clinical data, forced spirometry and 6min walking distance were determined, and the BODE index was calculated, at the time of inclusion in the study. During follow-up, sputum culture was obtained during exacerbations, and hospitalization and mortality were collected every two months. Mean age was 71 yrs, and 94% of patients were male. Main findings show that: 1) not all patients had severe disease according to either the degree of airflow limitation or the BODE index; 2) non-usual pathogens, mainly Pseudomonas aeruginosa, other gram-negative non-fermentative rods and Enterobacteriaceae, were isolated among 71.1% of the sputum obtained during exacerbations; and, 3) these pathogens were associated with poor prognosis and frequent hospitalization. CONCLUSIONS: Airway infection by non-usual pathogens appears to be a key driver of frequent hospitalizations and mortality in COPD.

[Newborns from assisted reproductive technology at the Hospital de São João]. / Recém-nascidos de reprodução medicamente assistida.

Over the last 20 years, assisted reproductive technology has been increasingly used. Ever since the first newborn resulting from artificial insemination, over two centuries ago, thousands more children were born resulting from these techniques. In Portugal, assisted reproductive technology began in 1985 at the Hospital de São João (HSJ). Although the success of these techniques is often judge by the pregnancy rate, occasionally by the birth rate, the most important issue of this evaluation should be the neonatal health. A retrospective study to evaluate the use of assisted reproductive technology at the HSJ, as well as the occurrence of complications during pregnancy and the evolution of the newborns in the neonatal period, during the period between 1999 and 2003, was undertaken. A hundred and thirty-eight pregnant women were included, which stands for about 1% of the total number of pregnant women at the HSJ in the period in question, with an average of age 32.2 +/- 4.1 and of infertility 6.2 +/- 3.8 years. The number of attempts for a successful pregnancy was 2.7 +/- 2.1. The most used technique was intracytoplasmatic sperm injection. Eighteen percent of the pregnancies resulted in abortion. The incidence of multiple pregnancies was 30%. A hundred and fifty-six infants were born, which stands for about 1% of the total number of births at the HSJ in the period in question, with a gestational age of 36.4 +/- 3 weeks and weight at birth of 2674.5 +/- 761.4 g. The incidence of preterm birth was 41%. Seventy-eight percent of the newborns had a good neonatal outcome, whereas the other 22% were admitted to a neonatal intensive care unit for an average period of 17 days. The most frequent neonatal morbidity was respiratory. One newborn died. Despite the need for several attempts of assisted reproductive technology, pregnancy complications, neonatal morbidity and mortality, the use of these techniques allowed for most couples to overcome their infertility problem.