Laparoscopic vs Open Extravesical Ureteral Reimplantation in Pediatric Population: A Single-Center Experience.

PURPOSE: To evaluate the safety and efficacy of conventional laparoscopic vs open Lich-Gregoir ureteral reimplantation in pediatric vesicoureteral reflux. MATERIAL AND METHODS: A retrospective study was conducted in a tertiary care hospital. Patients with vesicoureteral reflux who underwent open or laparoscopic Lich-Gregoir ureteral reimplantation from 2013-2020 were included.  The primary outcome was resolution of reflux. Complications and perioperative characteristics were evaluated. The outcomes between open and laparoscopic surgery were analyzed. RESULTS: A total of 110 patients and 150 ureters were included. The mean age was 4.5 years ± 3.4 and 73.6% were females. A total of 125 ureters (83.3%) underwent laparoscopic and 25 (16.6%) open Lich-Gregoir vesicoureteral reimplantation (5:1 Ratio). Resolution was reported in 112 (89.6%) for laparoscopy and 21 (84%) for open surgery (P = .42). Mean surgical time for laparoscopy and open surgery were 142.4 min ± 64.4 and 153 min ± 40, respectively (P =.29). Mean bleeding (9.5 mL ± 11.2 vs 29.6 mL ± 22.8) and length of hospital stay (2.4 days ± 2.3 vs 5.05 ± 3.1) were significantly higher with open surgery (P < .001). No significant difference in complications was reported between open surgery (32%) and laparoscopic approach (22.4%) (P = .305). CONCLUSION: Conventional laparoscopic vesicoureteral reimplantation with the Lich-Gregoir technique has an acceptable success rate comparable with open surgery, with shorter hospital stay, less bleeding, and less need of transfusion.

Role of rheumatoid factor isotypes and anti-citrullinated peptide antibodies in the differential diagnosis of non-selected patients with inflammatory arthralgia / Rol de los isotipos del factor reumatoide y los anticuerpos anti-péptido cíclico citrulinado en el diagnóstico diferencial de pacientes no seleccionados con artralgia inflamatoria

Background/ObjectivesRheumatoid arthritis (RA) is a chronic inflammatory disease characterized by swelling, tenderness and destruction of synovial joints, leading to severe disability and premature mortality. The aim of the study was to determine the diagnostic accuracy of the 3 isotypes of rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA) and the combination of both, for the diagnosis of rheumatoid arthritis (RA) in non-selected patients with inflammatory arthralgia.MethodsWe include 129 patients with inflammatory Arthalgia from a third level reference Center of rheumatic diseases in Monterrey, México. Their samples were analyzed for RF isotypes (IgA, IgG, and IgM) by ELISA (EUROINMUN), using a cut-off of 20IU/ml, and for ACPA's 5IU/ml; a medical examination was performed to obtain the definitive diagnoses of the patients. Data analysis was carried out using ROC curves for the measurement of sensitivity, specificity, for diagnostic accuracy to verify if the use of 3 RF isotypes and ACPA had a better prediction for the diagnosis of RA than use only one isotype and the ACPA alone.ResultsThe ROC showed a sensitivity and specificity of the different antibodies with different cut-off points, being the best for the IgM with 0.802 followed by ACPA, IgA and IgG with 0.771, 0.63, and 0.728 respectively without statistical difference, the sensitivity and specificity of the combination of the 4 antibodies were 81.4 and 73.66%.ConclusionIn non-selected patients with inflammatory arthralgia, the combination of ACPA and isotypes of RF did not demonstrate more sensibility and specificity than IgM isoform of rheumatoid factor measurement only. We recommend that in the clinical scenario of arthralgia, where the diagnoses are Lupus, Sjogren syndrome and Osteoarthritis, RF IgM isoform is used followed by ACPA.(AU)

Introduccion/objetivosLa artrtitis reumatoide (AR) es una enfermedad inflamatoria crónica caracterizada por inflamación, sensibilidad y destrucción de la membrana sinovial de las articulaciones, dando lugar a una discapacidad grave y mortalidad prematura. El objetivo del estudio fue determinar la precisión diagnóstica de los 3 isotipos del factor reumatoide (RF), los anticuerpos peptídicos anti citrulinados (ACPA) y la combinación de ambos, para el diagnóstico de AR en pacientes no seleccionados con artralgia inflamatoria.MétodosFueron incluidos 129 pacientes con artralgia inflamatoria de un centro de referencia de enfermedades reumáticas de tercer nivel en Monterrey, México. Sus muestras se analizaron para determinar los isotipos de RF (IgA, IgG e IgM) mediante ELISA (Euroinmun), usando un límite de 20UI/ml, y de 5UI/ml de ACPA. Se realizó un examen médico para obtener los diagnósticos definitivos de los pacientes. El análisis de los datos se realizó mediante las curvas ROC para la medición de la sensibilidad, la especificidad y la precisión diagnóstica para verificar si el uso de 3 isotipos de RF y ACPA tenía una mejor predicción para el diagnóstico de la AR que el uso de un solo isotipo y el ACPA solo.ResultadosLa curva ROC mostró una sensibilidad y especificidad de los diferentes anticuerpos con diferentes puntos de corte, siendo el mejor para el IgM con 0,802 seguido de ACPA, IgA e IgG con 0,771, 0,63 y 0,728, respectivamente, sin diferencia estadística; la sensibilidad y la especificidad de la combinación de los 4 anticuerpos fueron 81,4 y 73,66%.ConclusiónEn pacientes no seleccionados con artralgia inflamatoria, la combinación de ACPA e isotipos de RF no demostró más sensibilidad y especificidad que la isoforma IgM de la medición del RF solamente. Recomendamos que, en el escenario clínico de artralgia, donde los diagnósticos son lupus, síndrome de Sjögren y osteoartritis, se use la isoforma RF IgM seguida de los ACPA.(AU)

Role of rheumatoid factor isotypes and anti-citrullinated peptide antibodies in the differential diagnosis of non-selected patients with inflammatory arthralgia.

BACKGROUND/OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by swelling, tenderness and destruction of synovial joints, leading to severe disability and premature mortality. The aim of the study was to determine the diagnostic accuracy of the 3 isotypes of rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA) and the combination of both, for the diagnosis of rheumatoid arthritis (RA) in non-selected patients with inflammatory arthralgia. METHODS: We include 129 patients with inflammatory Arthalgia from a third level reference Center of rheumatic diseases in Monterrey, México. Their samples were analyzed for RF isotypes (IgA, IgG, and IgM) by ELISA (EUROINMUN), using a cut-off of 20IU/ml, and for ACPA's 5IU/ml; a medical examination was performed to obtain the definitive diagnoses of the patients. Data analysis was carried out using ROC curves for the measurement of sensitivity, specificity, for diagnostic accuracy to verify if the use of 3 RF isotypes and ACPA had a better prediction for the diagnosis of RA than use only one isotype and the ACPA alone. RESULTS: The ROC showed a sensitivity and specificity of the different antibodies with different cut-off points, being the best for the IgM with 0.802 followed by ACPA, IgA and IgG with 0.771, 0.63, and 0.728 respectively without statistical difference, the sensitivity and specificity of the combination of the 4 antibodies were 81.4 and 73.66%. CONCLUSION: In non-selected patients with inflammatory arthralgia, the combination of ACPA and isotypes of RF did not demonstrate more sensibility and specificity than IgM isoform of rheumatoid factor measurement only. We recommend that in the clinical scenario of arthralgia, where the diagnoses are Lupus, Sjogren syndrome and Osteoarthritis, RF IgM isoform is used followed by ACPA.

Relación entre microlitiasis testiculares y características clínicas en sujetos con cáncer testicular / Relationship between testicular microcalcifications and clinical characteristics in patients with testicular cancer

INTRODUCCIÓN: La microlitiasis testicular (MT) es un hallazgo clínico poco frecuente en población general masculina; dichas calcificaciones son reportadas por ultrasonidos testiculares y constituyen un hallazgo incidental. La presencia de MT se encuentra asociada a carcinoma testicular. OBJETIVOS: Analizar la relación entre variables clínicas, demográficas, comorbilidades y marcadores tumorales con la presencia o ausencia de microlitiasis en sujetos con cáncer testicular. MATERIAL Y MÉTODOS: Estudio retrospectivo donde se incluyó un total de 66 pacientes con diagnóstico de carcinoma testicular del año 2012 al 2017 en un hospital del noreste de México. Se dividió el total de los pacientes en 2 grupos según la presencia o ausencia de MT, y se analizaron las características clínicas de estos. RESULTADOS: La prevalencia general de MT fue de un 31,8%. El principal tumor observado en los reportes de patología fue el tumor de células germinales no seminomatoso (54,4%). La incidencia de metástasis a órganos fue del 27,3%. No se encontraron diferencias estadísticamente significativas al comparar las variables de interés en el grupo con y sin MT. Se encontró una relación entre la elevación de alfa-fetoproteína y los tumores no seminomatosos (p = 0,003). CONCLUSIONES: De acuerdo con los resultados obtenidos, se puede decir que las MT constituyen un hallazgo clínico que no tiene relación con el pronóstico de la enfermedad y que además no se relacionan con ninguna de las comorbilidades y datos clínicos analizados

INTRODUCTION: Testicular microlithiasis (TM) is an uncommon finding in general male population. These calcifications are reported by testicular ultrasound performed by some testicular pathology and constitute an incidental finding. The presence of TM is regularly associated to testicular neoplasms. OBJECTIVES: To investigate the relationship between clinical and demographic factors, comorbidities and tumor biomarkers, and the presence or absence of microlithiasis in patients with testicular cancer. MATERIAL AND METHODS: A retrospective study including a total of 66 patients diagnosed with testicular carcinoma from 2012 to 2017 in a hospital in Northeastern Mexico. The total of patients was divided into 2 groups according to the presence or absence of MT and the clinical features of these were analyzed. RESULTS: There was a general prevalence of TM of 31.8%. The main tumor found in the pathology reports corresponded to the non seminomatous germ cells tumor (54.4%). The incidence of metastasis to organs was of 27.3%. No statistically significant differences were found when comparing the variables of interest in the group with and without MT. A relationship was found between the elevation of alpha-fetoprotein and non-seminomatous tumors compared to seminomatous tumors (PY=Y.003). CONCLUSIONS: According to the results obtained, it can be suggested that TM is a clinical finding that is not related to the prognosis of the disease or any of the comorbidities and clinical data analyzed in our study

[Relationship between testicular microcalcifications and clinical characteristics in patients with testicular cancer]. / Relación entre microlitiasis testiculares y características clínicas en sujetos con cáncer testicular.

INTRODUCTION: Testicular microlithiasis (TM) is an uncommon finding in general male population. These calcifications are reported by testicular ultrasound performed by some testicular pathology and constitute an incidental finding. The presence of TM is regularly associated to testicular neoplasms. OBJECTIVES: To investigate the relationship between clinical and demographic factors, comorbidities and tumor biomarkers, and the presence or absence of microlithiasis in patients with testicular cancer. MATERIAL AND METHODS: A retrospective study including a total of 66 patients diagnosed with testicular carcinoma from 2012 to 2017 in a hospital in Northeastern Mexico. The total of patients was divided into 2 groups according to the presence or absence of MT and the clinical features of these were analyzed. RESULTS: There was a general prevalence of TM of 31.8%. The main tumor found in the pathology reports corresponded to the non seminomatous germ cells tumor (54.4%). The incidence of metastasis to organs was of 27.3%. No statistically significant differences were found when comparing the variables of interest in the group with and without MT. A relationship was found between the elevation of alpha-fetoprotein and non-seminomatous tumors compared to seminomatous tumors (PY=Y.003). CONCLUSIONS: According to the results obtained, it can be suggested that TM is a clinical finding that is not related to the prognosis of the disease or any of the comorbidities and clinical data analyzed in our study.