Divertículo calicial. Técnica quirúrgica: nuestra casuística / Caliceal diverticula. Surgical technique: report of cases

Objetivo: evaluar la tasa libre de cálculo y de obliteración del divertículo, con la técnica percutánea, en el tratamiento quirúrgico de los divertículos caliciales asociados a litiasis. Materiales y Métodos: se revisaron las historias clínicas de pacientes operados por divertículo calicial asociado a litiasis en su interior de 2004 a 2010. Fueron evaluados con Urocultivo, Rx simple de árbol urinario, Urograma Excretor y Tomografía de abdomen y pelvis. Se determinó la presencia del divertículo, su asociación a litiasis y su proyección anterior o posterior. Se realizó nefrolitotricia percutánea (NLPC) más dilatación del cuello del divertículo en todos los casos. Con respecto a la técnica quirúrgica, en decúbito ventral, previa colocación de un catéter ureteral tipo "open end". Se accedió directamente al divertículo, con dilatación hasta 30 Fr. Luego de realizar la litotricia neumática y extraer los fragmentos litiásicos, se dilató el cuello del divertículo hasta 18 Fr, dejando luego un catéter doble jota o un tubo de nefrostomía a través del cuello del mismo hasta la pelvis renal. Los resultados respecto a los restos litiásicos y al divertículo se evaluaron en el postquirúrgico inmediato con Rx árbol urinario y urocultivo, a los 6 meses con Urograma Excretor y luego anualmente con ecografía. Resultados: 11 pacientes fueron tratados con NLPC por divertículos caliciales asociados a litiasis. La edad promedio fue de 41,8 años (14-58). El seguimiento medio fue de 29,7 meses (12-70). Los 11 divertículos tenían proyección posterior y estaban asociados a liltiasis renal. En todos los casos se pudo identificar el cuello diverticular y se realizó la dilatación del mismo. En 8 pacientes se dejó un catéter doble J desde el divertículo hasta la vejiga y en 3 un tubo de nefrostomía (K-11) desde el divertículo hasta la pelvis renal. Ninguno de los pacientes presentó sangrado con requerimiento de transfusión, neumotórax ni hemotórax. La tasa libre de cálculo fue del 10%...

Objective: Assessing the stone-free rate and diverticulum obliteration with percutaneous technique in the managment of the caliceal diverticula associated with stones. Material and methods: We reviewed medical records of patients undergoing surgery for calyceal diverticulum associated with lithiasis from 2004 to 2010. They were evaluated by urine culture, simple urinary Rx, intravenous urography and CT. Percutaneous nephrolithotomy (PCNL) plus dilatation of the diverticular neck was performed in all cases. First an ureteral catheter open end type was placed. In prone position the diverticulum was accessed directly. After pneumatic lithotripsy and extraction of fragments, diverticular neck was dilated to 20 Fr, leaving a double J catheter or a nephrostomy tube. The results were evaluated immediately after surgery with urinary Rx and urien culture, at 6 months with intravenous urography and annual follow-up with ultrasound. Results: 11 patients were treated with PCNL for caliceal diverticula with stones. The mean age was 41,8 years (range 14-58). The mean follow up was 29,7 months (range 12-70). All caliceal diverticulum had a posterior projection. In all cases the diverticular neck was identify and the dilation was performed. None of the patients experienced pneumothorax or hemothorax and blood transfusions were not required. The stone-free rate was 100%, all patients had complete remission of symptoms. No recurrence of the diverticulum was observed during the follow up. Conclusions: the results proves that percutaneous management with dilation of the diverticular neck is secure, effective and mini invasive technique for the treatment of the caliceal diverticula associated with stones

Novel heteroaryl replacements of aromatic 3-tetrafluoroethoxy substituents in trifluoro-3-(tertiaryamino)-2-propanols as potent inhibitors of cholesteryl ester transfer protein.

A series of novel N,N-disubstituted trifluoro-3-amino-2-propanols has been prepared as potent inhibitors of cholesteryl ester transfer protein (CETP). Modifying the aromatic 3-tetrafluoroethoxy group in the lead molecule 1a with various heteroaryl moieties produced new 2-furyl analogues 2a,b with submicromolar potency in vitro.

Butenolide endothelin antagonists with improved aqueous solubility.

Continued development around our ETA-selective endothelin (ET) antagonist 1 (CI-1020) has led to the synthesis of analogues with improved aqueous solubility profiles. Poor solubility characteristics displayed by 1 required a complex buffered formulation in order to conduct iv studies. To overcome the use of specific iv formulations for preclinical studies on additional drug candidates, analogues with improved aqueous solubility were desired. Several analogues were synthesized with substitution patterns that allowed for the formation of either acid or base addition salts. These derivatives had dramatically improved aqueous solubility. In addition, these analogues retained equivalent or improved ETA receptor selectivity and antagonist potency, versus 1, both in vitro and in vivo. Compound 29, which contains as a substituent the sodium salt of a sulfonic acid, has an ETA IC50 = 0.38 nM, ETA selectivity of 4200-fold, and ETA functional activity of KB = 7.8, all of which are similar or superior to those of 1. Compound 29 also has vastly superior aqueous solubility and solubility duration, compared to 1. Furthermore, 29 after iv infusion displays improved activity to 1 in preventing acute hypoxia-induced pulmonary hypertension in rats with an ED50 = 0.3 microg/kg/h.

Hepatitis B and C virus sexual transmission among homosexual men.

OBJECTIVE: We estimated hepatitis B virus (HBV) and hepatitis C virus (HCV) sexual transmission among homosexual men. METHODS: Two hundred twenty-eight homosexually active men attending two clinical centers and presenting no risk factors except for sexual exposure were interviewed, and a blood sample was drawn. HBV marker test was performed using enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay, and HCV was tested using ELISA-2 and recombinant immunoblot assay-2. RESULTS: HBV and HCV infection prevalence rates were 34.4% and 12.7%, respectively. Using logistic regression analysis including sexual exposure and controlling for confounders, we found that anal receptive intercourse (odds ratio [OR] = 4.01; 95% confidence interval [CI] = 1.34-11.94), duration of homosexuality (OR = 3.43; 95% CI = 1.29-9.12), insertive anilingus (OR = 2.02; 95% CI = 1.06-3.87), and sexually transmitted diseases (OR = 1.87; 95% CI = 1.00-3.47) were independently associated with the risk of HBV sexual transmission. We did not find any association between sexual behavior and HCV transmission. CONCLUSIONS: Sexual behavior is a plausible explanatory factor of HBV sexual transmission among homosexual men. Further evidence is needed to elucidate the occurrence and the efficiency of HCV sexual transmission in the absence of other risk factors.

Synthesis of novel substituted pyridines as inhibitors of endothelin converting enzyme-1 (ECE-1).

A series of bi-aryl pyridine carboxylic acids has been prepared and evaluated as inhibitors of ECE-1. The analogs were prepared by Pd catalyzed cross couplings of halogenated pyridines with heteroaryl organo-boranes, -tinate or -zincate derivatives.