Spectralities of ADHD: hauntological diagnosis amidst agency, politics and pedagogies.

Hauntology has become an increasingly alluring concept in social sciences to reflect upon everyday life and how subjects dwell upon scenarios pervaded not only by the potency of the actual but also the haunting of the past and the virtual. Drawing on the concept of 'hauntology', we inquire about recurring temporalities and spectrality themes concerning the 'controversial' diagnosis of attention deficit hyperactivity disorder (ADHD) in Chile. Using participant observation and in-depth interviews with health practitioners, teachers, school staff, diagnosed children, and their peers from 3-year-long research, we examine how the performance of the diagnosis by clinicians at times can produce a modification of the temporality of the diagnosed children from that moment forth. Amidst tension created by educational policies, ideas of well-being, pedagogical practices, and everyday living, the diagnosis keeps repeating its agentic capacity while resisting its decay, becoming ever-present and actual. Once cast, the diagnosis acts as a repeating force that can shape every experience, cancelling the possibility for the child to become different by unfolding out of the diagnosis.

Care entanglements: Upholding difference through the uses of mental health diagnosis in Chilean schools.

This article draws upon findings from fieldwork conducted with Chilean mental health practitioners and school staff to explore how children's mental health diagnoses can be used in the school setting as a particular rationale to mobilise and convey new forms of care practices (Mol, The logic of care: Health and the problem of patient choice, 2008). Inspired by the framing of care as an interrelational, interdependent and more-than-human affair promoted by Science and Technology Studies, and drawing from conceptual tools offered by post-humanist approaches, we focus our examination on the diagnosis of attention deficit-hyperactivity disorder (ADHD). Following the diagnosis since its formulation by clinicians in the public sector to its enactment in an urban school in Santiago, Chile, we explore how certain caring/uncaring practices are enacted in relation to the diagnosis, reconfiguring the classroom by incorporating (non)human actors to care for the diagnosed child. However, care is ambivalent, and the diagnosis can be put into action for other purposes as it interweaves with educational policies and other agendas. Thus, to produce policies that truly foster inclusion, attention must be given to the micropolitical level where disabilities and disorders are enacted, developing appropriate ethico-political and affective sensitivities to care accordingly.

Morphological and Semi-empirical Study of the Pluronic F68/Imogolite/Sudan III Intersurfaces Composite for the Controlled Temperature Release of Hydrophobic Drugs.

Some PluronicF68 (F68) triblock copolymer properties demonstrate surprising applications in selective drug administration, such as the transportation of hydrophobic anti-inflammatories through epithelial barriers. Nuclear magnetic resonance (1H-NMR) spectroscopy was carried out for micelle precursor dispersions and F68 films modified with a synthetic imogolite (IMO) biocompatible hydrogel. Theoretical calculations and morphological assessment for the process of morphogenesis of dendritic crystallization were performed by molecular docking and atomic force microscopy (AFM) of the Sudan III-IMO-F68 composite, which was more hydrophobic than Sudan III-F68 and carried out the prolonged release of the Sudan III "drug" captured by a water-octanol interface determined by standard absorbance. Surface fusions were measured and compared to the unmodified matrix. However, despite the superior properties of the composite, the critical micelle concentration (CMC) was practically unmodified because solitary IMO strands attached to Sudan III formed Sudan III-IMO. These strands unraveled in a stable manner by expanding like a "spiderweb" in hydrophilic interfaces according to NMR analysis of the hydrogen one H1 polarization of Sudan III and F68 methyl, whose correlation relates hydrophobicity of Sudan III-IMO-F68 with dendrite properties from F68 concentrations. CMC and surface fusions equivalent to F68 surface properties, calculated by differential scanning calorimetry and dynamic Raman spectroscopy, were determined by AFM and high-resolution ellipsometry. Our results show highly specialized pharmacological applications since micelle surfaces expand, triggering maximum deliveries of "Drugs" from its interior to the physiological environment. The implanted sensor prototype determined equilibria reached Sudan III according to temperature (32-50 °C) and time it took to cross the membrane model 1-octanol (48 h). The findings suggest that the targested design of a F68-IMO-"Drug" would function as a microdevice for the prolonged release of hydrophobic drugs. In addition, the said microdevice could regenerate the damaged tissue in the central nervous system or other organs of the body. This is due to the fact that it could perform both tasks simultaneously, given the properties and characteristics acquired by the compatible material depending on the temperature of the physiological environment.

Nuevas subjetividades: una aproximación posthumanista y material a los procesos de encuentro entre niñas, niños y psicoestimulantes / New subjectivities: a posthumanist and neo-materialist approach to the processes of encounter between children and psychostimulant medication / Novas subjetividades: uma abordagem pós-humanista e material dos processos de encontro entre meninas, meninos e psicoestimulantes

Resumen: Este artículo propone un abordaje complejo y posthumanista a los diversos modos mediante los cuales niñas, niños y psicofármacos se co-afectan, determinando diversos devenires ontológicos a partir de esta interacción, en el nicho provisto por dos escuelas ubicadas en la zona oriente de Santiago de Chile. A partir de los resultados de una praxiografía que se extendió por ocho meses con niñas y niños de 9 y 10 años, se sostiene que es necesario pensar esta relación entre niñas, niños y psicofármacos desde coordenadas distintas a las provistas por las tesis de la medicalización. Esto, en tanto ellas reducen y achatan la noción de subjetividad a una posesión interna del individuo, y a una separación radical con el mundo, sostenida en una discutible idea de excepcionalismo humano. En respuesta a esta idea de subjetividad, se propone otra que permite un abordaje diferente al problema, en tanto es una subjetividad entendida en sus aspectos procesales, dinámicos, y últimamente sostenido en base a entramados con el mundo y con la medicación.

Abstract: This article advances a posthumanist and complex approach to the different ways in which children and psychostimulants can co-affect each other, enabling different ontological becomings thanks to the processes of coming together that took place in the niche provided by two schools located in East Side of Santiago, Chile. Grounded in the results of an 8-months praxiography with children aged 9 and 10-years old, I argue for the need of new coordinates to reflect upon these interactions, coordinates different to those granted by the medicalization thesis. This, inasmuch as their approach tends to flatten and reduce the subjectivity of the medicated child to an inner essence, radically separated from the world, which is sustained under a disputed idea of human expectionalism. In respond to this, I advance an idea of subjectivity which is relational, processual and sustained on entanglements with the world and with the medication.

Resumo: Este artigo propõe uma abordagem complexa e pós-humanista aos vários modos pelos quais meninos, meninas e psicofármacos se co-afetam, determinando diferentes devires ontológicos dessa interação, no nicho prestado por duas escolas localizadas na zona oriente de Santiago do Chile. A partir dos resultados de uma praxiografía que durou oito meses com meninas e meninos com idade entre 9 e 10 anos, argumenta-se que é necessário pensar sobre a relação entre crianças e psicofármacos a partir de coordenadas diferentes das previstas pelas teses da medicalização. Neste aspecto, estas teses reduzem e achatam a noção de subjetividade a uma posse interna do indivíduo, e uma separação radical do mundo, realizada em uma ideia discutível do excepcionalismo humano. Em resposta a esta idéia de subjetividade, propõe-se uma abordagem diferente para o problema, a partir de uma subjetividade entendida em seus aspectos processuais, dinâmicos e, finalmente, sustentada com base nas associações com o mundo e com a medicação.

Pharmaceutical entanglements: an analysis of the multiple determinants of ADHD medication effects in a Chilean school.

This article draws upon findings from ethnographic fieldwork conducted in a Chilean school to explore how the effects of globally circulating ADHD medications emerge within the localized contexts of everyday users. An analysis of observations of children on ADHD medications within classroom settings is developed which challenges the assumption, pervasive within biomedical paradigms, that the effects of such medications can be understood as resulting directly from their chemical properties and biological modes of action. Our case study highlights the significance of multiple, interacting determinants of drug effects in an everyday setting, focusing in particular on classroom dynamics, teacher-student relations, and the agency of children taking the medications. We conclude that while ADHD medications may act in part by altering physiological processes, an adequate account of their effects requires that analytic attention extends to the sociomaterial contexts in which medications and users are embedded.

Tumores paratesticulares. Descripción de nuestra casuistica general a lo largo de un periodo de 25 años / Paratesticular tumors. Description of our case series through a period of 25 years

OBJETIVO: Los tumores paratesticulares son masas de crecimiento lento e indolente y en la mayoría de los casos son benignos (70%), en cuyo caso el tratamiento es la exéresis local de la lesión y seguimiento basado únicamente en la observación. Aquellos identificados como malignos (30%) el tratamiento es más complejo, consistiendo en orquiectomía radical asociado a quimioterapia o radioterapia adyuvante. Este trabajo pretende describir nuestra casuística de masas paratesticulares de los últimos 25 años y hacer un análisis comparativo con los datos publicados en la literatura mundial. Describir nuestra experiencia con los tumores paratesticulares, su incidencia, datos demográficos y tratamiento en un período de 25 años. MÉTODOS: estudio descriptivo y retrospectivo en que se analizaron las historias clínicas de 16 pacientes con el diagnostico de tumor paratesticular tratados en el Hospital de Móstoles entre 1984 y 2010 analizando la edad, el tipo de tumor, el tratamiento y su seguimiento. RESULTADOS: La edad media fue de 50 años (rango: 16-88), se detectaron tumores benignos en un 76% y malignos en un 24% de los casos. El tumor más frecuentemente reportado en nuestra muestra fue el leiomioma (23,5%), con leve predominancia del lado derecho (53%), el epidídimo fue la localización más frecuente (50%) y tamaño medio de 4,9 cm de diámetro. El seguimiento medio fue de 34 meses sin ningún tipo de recidiva o complicación en ningún paciente. CONCLUSIONES: Aunque hasta un 76% de los tumores paratesticulares son de naturaleza benigna, es recomendable siempre hacer un análisis anatomopatológico intraoperatorio de todas las lesiones. Al tener un diagnóstico de benignidad la exéresis simple de la lesión es tratamiento de elección. En nuestro estudio la mayoría de los tumores paratesticulares se diagnosticaron en la edad adulta (media de 51 años), el más frecuente fue el leiomioma y la localización más habitual fue en el epidídimo(AU)

INTRODUCTION: Paratesticular tumors are masses of slow and indolent growth and in most cases of benign nature (70 %), being that the case, the treatment of choice is simple extirpation of the lesion and follow-up, based on observation only. On those identified as malignant (30 %), treatment is more complex, consisting in radical orchiectomy with adjuvant chemotherapy or radiotherapy. This work tries to describe our case series of paratesticular tumors over the last 25 years and to make a comparative analysis with the information published in the world literature. OBJECTIVE: To describe our experience with paratesticular tumors, their incidence, demographic data and treatment over a period of 25 years. METHODS: Descriptive study where we analyzed clinical data of 16 patients with the diagnosis of paratesticular tumor treated at Mostoles Hospital between 1984 and 2010 analyzing the age, type of tumor, treatment and follow-up. RESULTS: Mean age was 50 years (range: 16-88), benign tumors were detected in 76 % of the cases and malignant in 24%. The tumor more frequently found in our series was leiomyoma (23.5%), with slight predominance of the right side (53 %); the most frequent location was the epididymis (50%) and mean size was 4.9 cm of diameter. The mean follow up was 34 months without complications or tumor relapse in any patient. CONCLUSIONS: Despite only three-quarters of paratesticular tumors are non-malignant, it is always advisable to do intraoperative pathological analysis of all this masses. Having a non-malignant diagnosis, the treatment of choice is simple extirpation of the mass. In our study the majority of the tumors were diagnosed in adult age (average 51 years), the most frequent was leiomyoma and the most common location was the epididymis(AU)

Paratesticular tumors. Description of our case series through a period of 25 years.

INTRODUCTION: Paratesticular tumors are masses of slow and indolent growth and in most cases of benign nature (70 %), being that the case, the treatment of choice is simple extirpation of the lesion and follow-up, based on observation only. On those identified as malignant (30 %), treatment is more complex, consisting in radical orchiectomy with adjuvant chemotherapy or radiotherapy. This work tries to describe our case series of paratesticular tumors over the last 25 years and to make a comparative analysis with the information published in the world literature. OBJECTIVE: To describe our experience with paratesticular tumors, their incidence, demographic data and treatment over a period of 25 years. METHODS: Descriptive study where we analyzed clinical data of 16 patients with the diagnosis of paratesticular tumor treated at Mostoles Hospital between 1984 and 2010 analyzing the age, type of tumor, treatment and follow-up. RESULTS: Mean age was 50 years (range: 16-88), benign tumors were detected in 76 % of the cases and malignant in 24%. The tumor more frequently found in our series was leiomyoma (23.5%), with slight predominance of the right side (53 %); the most frequent location was the epididymis (50%) and mean size was 4.9 cm of diameter. The mean follow up was 34 months without complications or tumor relapse in any patient. CONCLUSIONS: Despite only three-quarters of paratesticular tumors are non-malignant, it is always advisable to do intraoperative pathological analysis of all this masses. Having a non-malignant diagnosis, the treatment of choice is simple extirpation of the mass. In our study the majority of the tumors were diagnosed in adult age (average 51 years), the most frequent was leiomyoma and the most common location was the epididymis.

Synaptic localization of acylpeptide hydrolase in adult rat telencephalon.

Acylpeptide hydrolase (ACPH), a serine protease present in the central nervous system (CNS), is believed to have a function in modulating synaptic plasticity, cleavage of beta amyloid peptide and degradation of aggregated oxidized proteins. In this report, we demonstrate for the first time the presence of ACPH in the synapse and its preferential localization at the pre-synaptic side. We isolated subcellular fractions from the rat telencephalon enriched in pre- versus post-synaptic components by using differential centrifugation steps to evaluate ACPH catalytic activity and expression level. Relative ACPH levels were determined by Western blot techniques while antibodies against synaptophysin and PSD-95 were used as positive pre- and post-synaptic markers, respectively. Our results show that ACPH protein levels are significantly increased at the synapse, which correlates with a 56% increase in ACPH activity. Furthermore, Western blot experiments show that ACPH is preferentially located at the pre-synaptic side and this is consistent with the increase of its enzymatic activity in fractions enriched in pre-synaptic components. These results give new insights regarding the localization and a putative role of ACPH in the CNS.

Effect of short-term exposure to dichlorvos on synaptic plasticity of rat hippocampal slices: involvement of acylpeptide hydrolase and alpha(7) nicotinic receptors.

Dichlorvos is the active molecule of the pro-drug metrifonate used to revert the cognitive deficits associated with Alzheimer's disease. A few years ago it was reported that dichlorvos inhibits the enzyme acylpeptide hydrolase at lower doses than those necessary to inhibit acetylcholinesterase to the same extent. Therefore, the aim of our investigation was to test the hypothesis that dichlorvos can enhance synaptic efficacy through a mechanism that involves acylpeptide hydrolase instead of acetylcholinesterase inhibition. We used long-term potentiation induced in rat hippocampal slices as a model of synaptic plasticity. Our results indicate that short-term exposures (20 min) to 50 microM dichlorvos enhance long-term potentiation in about 200% compared to the control condition. This effect is correlated with approximately 60% inhibition of acylpeptide hydrolase activity, whereas acetylcholinesterase activity remains unaffected. Paired-pulse facilitation and inhibition experiments indicate that dichlorvos does not have any presynaptic effect in the CA3-->CA1 pathway nor affect gabaergic interneurons. Interestingly, the application of 100 nM methyllicaconitine, an alpha(7) nicotinic receptor antagonist, blocked the enhancing effect of dichlorvos on long-term potentiation. These results indicate that under the exposure conditions described above, dichlorvos enhances long-term potentiation through a postsynaptic mechanism that involves (a) the inhibition of the enzyme acylpeptide hydrolase and (b) the modulation of alpha(7) nicotinic receptors.

Desarrollo de un protocolo para la derivación de los pacientes con células atípicas en el sedimento urinario: experiencia del hospital de Móstoles / Development of a protocol for the referral of patients with atypical cells in the urinary sediment: Experience of Móstoles (Madrid) hospital

Introducción. El Servicio de Bioquímica del Hospital General de Móstoles (Madrid) ha diagnosticado durante muchos años la presencia de células atípicas en el sedimento urinario (CAS) y se ha limitado a exponerlo en el informe final del urianálisis. Material y métodos. Desde el año 2004 implantamos un protocolo de actuación conjunta con el servicio de anatomía patológica para el estudio citológico de las muestras de sedimento urinario con CAS. En un primer estudio piloto se comprobó la validez del sedimento urinario para el análisis citológico a pesar de las diferencias en el procesamiento de las muestras. Tras confirmarla, se procedió a establecer el protocolo de actuación. Las muestras con CAS son llevadas al servicio de anatomía patológica para estudio citológico convencional. Resultados. Cuarenta y uno de los casos remitidos fueron considerados positivos en el análisis citológico lo que supone un 44%, y 52 fueron negativos (56%). Un 48% de las muestras procedían de atención primaria y el 67% de los carcinomas correspondieron a pacientes con este origen. La edad media de los pacientes con neoplasias es de 70 años y el 70,8% son varones. En el 50% de los casos positivos los pacientes no presentaban sintomatología urológica. Discusión. Con esta nueva estrategia podemos confirmar directamente si las CAS corresponden a neoplasia urotelial o a otro proceso, lo que reduce el tiempo de diagnóstico de nuestros pacientes y evita estudios innecesarios en los casos negativos (AU)

Introduction. The Department of Clinical Chemistry of Móstoles General Hospital (Madrid, Spain) has diagnosed the presence of atypical cells in the urinary sediment (ACUS) for many years , but this finding only led to a comment in the urinalysis final report, informing the clinician of this fact in case it was decided to perform further studies in these patients. Material and methods. The Clinical Chemistry Department together with the Hospital Department of Surgical Pathology introduced a new protocol in 2004, according to which all the urinary sediment samples with ACUS are sent for cytological analysis. A preliminary pilot study was performed to confirm whether the urinary sediment would be suitable for pathological analysis. Results. In our first 93 samples we had a confirmatory diagnosis of malignancy in 41 patients (44%). Forty-eight percent of all the samples and 67% of the positive ones were from primary care. The mean age of the patients with positive samples was 70 years and 70.8% were men. In 50% of the cases the reason for the urinary analysis was non-urological. Discussion. With this new strategy we can directly diagnose whether the ACUS are associated with a carcinoma or another process, and this has allowed us to reduce time until diagnosis in our patients and also to avoid unnecessary studies in negative cases (AU)

[Endoscopic treatment of the vesicoureteral reflux in children: preliminary experience with the subureteral injection of Coaptite]. / Tratamiento endoscópico del reflujo vesicoureteral en pediatría: experiencia preliminar con la inyección subureteral de Coaptite.

OBJECTIVE: To review our experience in the endoscopic treatment of vesicoureteral reflux (VUR) in children with the subureteral injection of calcium hydroxyapatite (Coaptite). METHODS: The serie includes thirteen children whose age ranged between 6 and 13 years. The Coaptite implant was injected subureterally to 20 ureteral units (UU) affected by VUR grades I-IV. VUR was unilateral in six patients (46%), bilateral in seven (54%). There were 7 primary cases and 6 secondary to bladder dysfunction and duplex systems. RESULTS: Mean follow-up was 19 months (6-28 months). VUR was cured in 75% of cases after a single injection. A second injection resolved 2 out of 4 treated UU (50%) rendering a global success rate of 85%. This cure rate was achieved for 13 and 7 procedures treating primary and secondary VUR, respectively. 77% of patients reported no adverse events with only 23% of them complaining of transient mild lumbar and hypogastric discomfort limited to the first postoperative day. In 2 children postoperative urinary infection was detected. CONCLUSIONS: Endoscopic subureteral injection with Coaptite is a simple technique well tolerated in children. In 85% of primary and secondary cases cure was achieved with minimal morbidity.

Tratamiento endoscópico del reflujo vesicoureteral en pediatría: Experiencia preliminar con la inyección subureteral de Coaptite® / Endoscopic treatment of the vesicoureteral reflux in children: preliminary experience with the subureteral injection of coaptite

OBJETIVO: Analizar nuestra experiencia en el tratamiento endoscópico del reflujo vesicoureteral (RVU) en pediatría, mediante la inyección subureteral de hidroxiapatita cálcica (Coaptite®).MÉTODOS: La serie incluye trece niños de edades entre los 6 y 13 años. La inyección endoscópica subureteral de Coaptite® se aplicó en 20 unidades ureterales (UU) que presentaban RVU grados I-IV. El RVU fue unilateral en 6 pacientes (46%) y bilateral en 7 (54%). Hubo 7 casos primarios y 6 secundarios a disfunción vesical y duplicidad ureteral.RESULTADOS: El tiempo medio de seguimiento fue de 19 meses (6-28 meses). Se logró la corrección del RVU tras una inyección endoscópica en 15 casos (75%). Una segunda inyección corrigió el RVU en 2 de otras 4 UU (50%) tratadas, con lo que la cifra global de curacionesascendió al 85%. Esta tasa de curación se obtuvo tanto en los procedimientos que trataron casos primarios (13), como en las intervenciones por RVU secundario (7). Un 77% de pacientes no presentaron complicaciones, si bien el 23% tuvieron molestias lumbarese hipogástricas autolimitadas al primer día tras el procedimiento. En 2 niños se detectó infección urinaria en el postoperatorio.CONCLUSIONES: El tratamiento endoscópico del RVU con Coaptite® es una técnica sencilla y bien tolerada en niños. El 85% de los casos, tanto primarios como secundarios, curaron con mínima morbilidad

OBJECTIVE: To review our experience in the endoscopic treatment of vesicoureteral reflux (VUR) in children with the subureteral injection of calcium hydroxy-apatite (Coaptite®).METHODS: The serie includes thirteen children whose age ranged between 6 and 13 years. The Coaptite ® implant was injected subureterally to 20 ureteral units (UU) affected by VUR grades I-IV. VUR was unilateral in six patients (46%), bilateral in seven (54%). There were 7 primary cases and 6 secondary to bladder dysfunction and duplex systems.RESULTS: Mean follow-up was 19 months (6-28 months). VUR was cured in 75% of cases after a single injection. A second injection resolved 2 out of 4 treated UU (50%) rendering a global success rate of 85%. This cure ratewas achieved for 13 and 7 procedures treating primary and secondary VUR, respectively. 77% of patients reported transient mild lumbar and hypogastric discomfort limited to the first postoperative day. In 2 children postoperative urinary infection was detected.CONCLUSIONS: Endoscopic subureteral injection with Coaptite® is a simple technique well tolerated in children. In 85% of primary and secondary cases cure was achieved with minimal morbidity

[Cerebellum and lower urinary tract]. / Cerebelo y tracto urinario inferior.

OBJECTIVES: To review the role of cerebellum on the lower urinary tract dynamics. METHODS: Anatomic-functional methodology including structural, functional and neurotransmitters study. RESULTS: We describe the complex connections of the cerebellum and its influence on the lower urinary tract function. CONCLUSIONS: It is surprising the functional relationship between cerebellum and lower urinary tract, playing a inhibitory modulating role during the filling phase and facilitating the voiding phase.

Cerebelo y tracto urinario inferior / Cerebellum and lower urinary tract

OBJETIVO: Revisar el papel del cerebeloen la dinámica del tracto urinario inferior. MÉTODO: Metodología anatomofuncional que incluyeestudio estructural, funcional y de neurotransmisores. RESULTADOS: Se describen las complejas conexionesdel cerebelo y su influencia sobre la función del tractourinario inferior. CONCLUSIONES: Es sorprendente la interrelación funcionalentre cerebelo y tracto urinario inferior, ejerciendoun papel modulador inhibitorio durante la fase dellenado y facilitador durante la fase de vaciado (AU)

OBJECTIVES: To review the role of cerebellum on the lower urinary tract dynamics. METHODS: Anatomic-functional methodology including structural, functional and neurotransmitters study. RESULTS: We describe the complex connections of the cerebellum and its influence on the lower urinary tract function. CONCLUSIONS: It is surprising the functional relationship between cerebellum and lower urinary tract, playing a inhibitory modulating role during the filling phase and facilitating the voiding phase (AU)

[Urogenital alterations in hereditary and sporadic neurodegenerative ataxias]. / Alteraciones urogenitales en las ataxias neurodegenerativas hereditarias y esporádicas.

INTRODUCTION: Sporadic and hereditary ataxias (HA) represent a group of clinically and genetically heterogeneous syndromes characterized by spinocerebellar degeneration producing a motoneuron coordination disorder. In these diseases urinary and sexual symptoms are commonly associated to the neurological alterations. OBJECTIVE: To define the prevalence of functional low urinary tract symptoms in an ataxic population and to compare them with the symptomatology control a group of in healthy subjects. PATIENTS AND METHODS: An observational, descriptive, transversal study of 491 subjects recruited from the HA regional associations of Spain was conducted. In addition, a case-control study of prevalent ataxic patients and healthy subjects matched by sex and age was also performed. RESULTS: Among 195 patients included, 138 (70.8 %) had Friedreich ataxia (FA) and 57 (29.2 %) non-Friedreich ataxia (nFA). Global mean age was 32.3 years in FA and 43.7 in nFA patients (p < 0.05). Combined irritative and obstructive symptoms were present in 48.7 %, only irritative in 16.4 % and obstructive in 15 % of patients. Erectile dysfunction in 30.3 % (p < 0.01) and decreased libido in 13.4 % (p < 0.01), were the most common sexual problems. CONCLUSIONS: In HA, urinary symptoms are present in 80 % of patients, with mainly irritative symptoms in 2/3 of them. A complete urodynamic evaluation in symptomatic patients is recommended in order to characterize potential neurogenic vesico-urethral dysfunction. Even though sexual dysfunction may be related to neurological causes, additional etiologic organic factors should be excluded.

Alteraciones urogenitales en las ataxias neurodegenerativas hereditarias y esporádicas / Urogenital alterations in hereditary and sporadic neurodegenerative ataxias

Introducción. Las ataxias hereditarias (AH) y esporádicas comprenden un grupo de síndromes clínica y genéticamente heterogéneos, caracterizados por un trastorno variable de coordinación motora secundario a degeneración espinocerebelosa. Cabe esperar, como en otras enfermedades neurológicas, que junto al cuadro clínico neurológico se asocien síntomas urinarios y sexuales. Objetivo. Conocer la prevalencia de síntomas urinarios y sexuales en una población definida de pacientes atáxicos respecto a un grupo control de sujetos sanos. Pacientes y métodos. Estudio observacional, descriptivo, de corte transversal sobre una muestra de pacientes atáxicos pertenecientes a las asociaciones regionales de AH en España. Los sujetos a estudio fueron evaluados mediante un cuestionario de síntomas. Se trata de un estudio comparativo caso-control sobre una serie de casos prevalentes de sujetos atáxicos y un grupo control de población sana, pareado por sexo y edad. Conceptualmente se investiga la situación clínica referida a abril de 2002, aunque la recogida de información se prolongó durante 6 meses. Resultados. En abril de 2002 estaban asociados en España 491 pacientes atáxicos. Disponemos de datos sobre 195 pacientes, de los que 138 (70,8 %) eran ataxias de Friedreich (AF) y 57 (29,2 %) ataxias no Friedreich (NF). Edad media global de la AF era de 32,3 años frente a los 43,7 años de las NF (p < 0,05). En su evolución presentaron síndrome urinario mixto el 48,7 %, síntomas urinarios irritativos el 16,4 % y síntomas urinarios obstructivos el 14,9 %. Los trastornos sexuales más frecuentes en varones fueron disfunción eréctil (30,3 %) (p < 0,01) y disminución del deseo sexual (13,4 %) (p < 0,01). Conclusiones. En las AH neurodegenerativas pueden presentarse síntomas urinarios leves o moderados en un alto porcentaje de pacientes, predominando los síntomas urinarios irritativos. Recomendamos estudio urodinámico completo en pacientes sintomáticos con objeto de caracterizar la posible disfunción neurógena vesicouretral. Aunque la disfunción sexual puede atribuirse a fenómeno neurológico, existen otros factores orgánicos involucrados en su patogenia, lo que implica un enfoque multidisciplinar

Introduction. Sporadic and hereditary ataxias (HA) represent a group of clineally and genetically heterogeneous syndromes characterized by espinocerebellar degeneration producing a motoneuron coordination disorder. In these diseases urinary and sexual symptoms are commonly associated to the neurological alterations. Objective. To define the prevalence of functional low urinary tract symptoms in an ataxic population and to compare them with the symptomatology control a group of in healthy subjects. Patients and methods. An observational, descriptive, transversal study of 491 subjects recruited from the HA regional associations of Spain was conducted. In addition, a case-control study of prevalent ataxic patients and healthy subjects matched by sex and age was also performed. Results. Among 195 patients included, 138 (70.8 %) had Friedreich ataxia (FA) and 57 (29.2 %) non-Friedreich ataxia (nFA). Global mean age was 32.3 years in FA and 43.7 in nFA patients (p<0.05). Combined irritative and obstructive symptoms were present in 48.7 %, only irritative in 16.4 % and obstructive in 15 % of patients. Erectile dysfunction in 30.3 % (p < 0.01) and decreased libido in 13.4 % (p < 0.01), were the most common sexual problems. Conclusions. In HA, urinary symptoms are present in 80 % of patients, with mainly irritative symptoms in 2/3 of them. A complete urodynamic evaluation in symptomatic patients is recommended in order to characterize potential neurogenic vesico-urethral dysfunction. Even though sexual dysfunction may be related to neurological causes, additional etiologic organic factors should be excluded

[Treatment approach for vesicogenital fistula. Retrospective analysis of our data]. / Planteamiento terapéutico de las fístulas vesicogenitales. Análisis retrospectivo de nuestra serie.

The vesicogenital fistula are abnormal communications between female genitalia and urinary bladder. We recorded all the vesicogenital fistula diagnosed since 1986, analyzing aetiology, treatment applied, complications and results. Total number of fistula have been 20 (18 vesicovaginal and 2 vesicouterine). The distribution in vesicovaginal fistula was iatrogenic in 15 cases (83%) and tumoral in 3 cases (17%). Vesicouterine fistula were due to cesarean. The initial treatment of the iatrogenic fistula was conservative using foley catheter. Twenty percent of the patients were cured with this treatment (3 cases). Surgical repair was necessary for the other patients, using different surgical approach according to the type of the fistula, intensity and patient age. It was successful in 91% of the patients. The results shows that simple surgical approach generate less morbidity and the early intervention is not less efficient.

Planteamiento terapéutico de las fístulas vesicogenitales. Análisis retrospectivode nuestra serie / Treatment approach for vesicogenital fistula. Restrospective analysis of our data

Las fístulas vesicogenitales son comunicaciones anómalas de la vejiga urinaria con cualquier parte del aparato genital femenino. En el presente trabajo analizamos nuestra serie de fístulas vesicogenitales diagnosticadas y tratadas desde 1986, analizando las causas etiológicas, tratamientos aplicados, complicaciones y resultados de los mismos.El número total de fístulas han sido 20 (18 vesicovaginales y 2 vesicouterinas). De las fístulas vesicovaginales 15 (83 por ciento) eran yatrógenas y 3 (17 por ciento) neoplásicas. Las fístulas vesicouterinas aparecieron tras sendas cesáreas.El tratamiento inicial de las fístulas yatrógenas fue conservador con sondaje vesical, produciéndose su resolución en el 20 por ciento de las mismas (3 casos). En el resto de las pacientes se realizó tratamiento quirúrgico por vía abdominal con distintas técnicas según el tipo de fístula, intensidad y edad de la paciente, resultando satisfactorio en el 91 por ciento de los casos. La utilización de técnicas sencillas que generan menor morbilidad así como la actuación precoz no implica un peor resultado en las fístulas yatrógenas simples. (AU)

Evolución y pronóstico a medio y largo plazo de los tumores vesicales superficiales / Outcome and medium and long-term prognosis of superficial transitional cell carcinoma of the bladder

OBJETIVOS: Evaluar la evolución de 551 pacientes con carcinomas transicionales vesicales. Mediante el análisis log-rank de las curvas de Kaplan-Meier y análisis multivariante con regresión de Cox, analizamos factores pronósticos en base a la supervivencia libre de enfermedad (SLE), supervivencia libre de progresión a infiltrantes (SLP) y supervivencia específica (SE), con el fin de agrupar a los pacientes en base a sus factores de riesgo reales. MATERIAL Y MÉTODOS: Desde 1983 hasta 1998 se han controlado en nuestro centro 551 pacientes con tumores vesicales superficiales. En este grupo se incluyen 15 pacientes diagnosticados con anterioridad a 1983 en otros centros. Los historiales clínicos están actualizados al periodo 19982000 salvo en 21 pacientes (3,8 por ciento) perdidos para seguimiento. El seguimiento medio ha sido de 6,2 años (mediana 5,3). Han fallecido 111 pacientes (20 por ciento) en una media de 4,5 años (mediana 3,4). Siguen vivos 440 pacientes con un seguimiento medio de 6,6 años (rango 2-24 años, mediana 5,7).RESULTADOS: Hombres han sido 459 (83 por ciento) con una edad media de 64 años, mujeres 92 (17 por ciento) con una edad media de 70. En 347 pacientes había un solo tumor (63 por ciento). Tumores Ta: 79 (14 por ciento), T1: 431 (78 por ciento), Tis: 41(7 por ciento). G1: 406 (74 por ciento), G2: 96 (17 por ciento), G3: 33 (6 por ciento) y Tis primario: 16 (3 por ciento).Han recidivado 253 pacientes (46 por ciento) en una media de 2,2 años. SLE a 5 años: 55 por ciento, a 10 años: 44 por ciento, a 15 años: 38 por ciento. En análisis multivariante han tenido significación estadística desfavorable para la SLE: los tumores múltiples con un riesgo relativo (RR) de 1,4 (IC: 1,19-1,69); la edad avanza-da en variable continua y el sexo femenino (RR: 1,2; IC: 0,98-1,52).Han progresado a infiltrantes 40 pacientes (7,3 por ciento) en una media de 3,3 años. SLP a 5 años: 93 por ciento, a 10 años: 91 por ciento, a 15 años: 90 por ciento. Factores des-favorables en multivariante para SLP: tumores G3 (RR: 5,1; IC: 2,7-9,6); el grupo de riesgo integrado por: tumores Ta-T1G3 o Tis o T1G2 múltiples (RR: 4,6; IC: 2,6-7,9); y la edad mayor de 70 años (RR: 2,14; IC: 1,2-3,7).Han fallecido por su tumor: 31 pacientes (5,6 por ciento) en una media de 4,6 años. SE a 5 años: 95 por ciento, a 10 años: 93 por ciento, a 15 años: 91 por ciento. Factores significativos en multivariante para SE: el mismo grupo de riesgo significativo en SLP (RR: 5; IC: 2,7-9) y los pacientes con edad superior a 70 años (RR: 4,56; IC: 2,2-8,8).CONCLUSIONES: La capacidad de recidiva es muy elevada en todos los pacientes siendo el riesgo mayor cuando existen tumores múltiples. La posibilidad de progresión es baja pero existe incluso en los pacientes con tumores muy poco agresivos. El grupo de riesgo más elevado es el integrado por los pacientes con tumores Ta-T1G3 o Tis o T1G2 múltiples (AU)

[Clinical course and mid- and long-term prognosis of superficial bladder tumors]. / Evolución y pronóstico a medio y largo plazo de los tumores vesicales superficiales.

OBJECTIVES: To evaluate the outcome of 551 patients with superficial transitional cell carcinomas of the bladder. To determine prognostic factors in these patients by means of the log-rank analysis of the Kaplan-Meier curves and a multivariate analysis with Cox regression model for the disease free survival (DFS), time to progression to infiltrating lesions (TTP) and overall survival (OS). MATERIAL AND METHODS: Between 1983 and 1998 we have seen 551 patients with superficial transitional cell carcinomas of the bladder in our Hospital. Fifteen patients included in this series had been diagnosed in other hospitals before 1983. The clinical records were actualized between 1998 and 2000 and only 21 patients were lost to follow-up (3.8%). The mean follow-up time was 6.2 years (median time: 5.3). One hundred and eleven patients (20%) died with a mean of 4.5 years (median time 3.4). Four hundred and forty patients were still alive on completion of the study with a mean follow-up time of 6.6 years (range 2-24 years; median 5.7). RESULTS: Four hundred and fifty-nine patients were men (83%) with a mean age of 64 years and 92 were women (17%) with a mean age of 70 years. In 347 patients there was only one tumour (63%). The tumours were stage Ta in 79 cases (14%). T1 in 431 (78%) and Tis in 41 (7%). The histological grade was G1 in 406 cases (74%), G2 in 96 (17%) and G3 in 33 (6%). There were recurrences in 253 patients (46%) with a mean time of 2.2 years. The DFS was 55% at 5 years, 44% at 10 years and 38% at 15 years. The multivariate analysis has shown a negative prognostic influence on DFS of the presence of multiple tumours (RR 1.4 CI 1.19-1.69), increasing age (analysed as a continuous variable) and the sex (being worse for females; RR 1.2 CI 0.98-1.52). In 40 patients (7.3%) the tumour became infiltrative in a mean of 3.3 years. The TTP was 93% at 5 years, 91% at 10 years and 90% at 15 years. The negative prognosticators in the multivariate analysis were G3 tumour (RR: 5.1 CI 2.7-9.6), the group of tumours Ta-T1G3 or multiple T1G2 or Tis (RR 4.6 CI 2.6-7.9) and the age > 70 years (RR 2.14 CI 1.2-3.7). Thirty-one patients (5.6%) died of the tumour in a mean time of 4.6 years. The OS was 95% at 5 years, 93% at 10 years and 91% at 15 years. Significant prognosticators in the multivariate analysis for OS were the group of risk tumours Ta-T1G3 and multiple Tis or T1G2 (RR 5 CI 2.7-9) and age > 70 years (RR 4.56 CI 2.2-8.8). CONCLUSIONS: The recurrence rate is very high in all the patients, but the risk is highest when the tumours are multiple. The risk of progression is low, but still exits even in patients with tumours of low malignant potential. The highest risk is associated with Ta-T1G3 of Tis or multiple T1G2.