Detección del virus herpes simple tipo 2 en mujeres indígenas del estado Zulia / Detection of herpes simplex type 2 in indian women state Zulia

El virus herpes simple tipo 2 (VHS-2), es una infección de transmisión sexual prevalente en el mundo a pesar de los avances diagnósticos y terapéuticos. Según estimaciones en el 2012, se calculaba que existían 417 millones de personas infectadas en todo el mundo. El objetivo de este proyecto fue detectar el VHS-2 en mujeres indígenas del estado Zulia, para ello se seleccionaron 100 mujeres de las etnias wayúu y añú sin discriminar edad y/o paridad. El médico procedió a realizar la toma de muestras con un hisopo de alginato, para el procesamiento de las mismas se utilizó el método de Reacción en Cadena de la Polimerasa (PCR) para detectar el VHS-2, en muestras de origen cérvico-uterino, y el diagnostico citológico se realizó a través de la coloración con hematoxilina- eosina. Se obtuvo un 22% de muestras positivas para VHS-2, los hallazgos obtenidos, demuestran que un porcentaje considerable de las pacientes presentan infección por el VHS- 2, siendo este de suma importancia debido a que el mismo puede contribuir a la progresión de procesos inflamatorios persistentes.

The herpes simplex virus type 2 (HSV-2) is a sexually transmitted infection prevalent in the world; in spite of despite diagnostic and therapeutic advances. According to estimates in 2012, it was calculated that there were 417 million people infected worldwide. The objective of this project was to detect HSV-2 in indigenous women of the Zulia state, for that 100 women of the Wayúu and Añú ethnic groups, were selected without discriminating age and/or parity. The physician proceeded to sample with an alginate swab, for the processing of the same was used the polymerase chain reaction (PCR) method to detect HSV-2 in samples of cervical-uterine origin, and cytological diagnosis was made through staining with hematoxylin-eosin. 22% of HSV-2 positive samples were obtained, the results show that a considerable percentage of patients present HSV-2 infection, which is extremely important because it can contribute to the progression of processes inflammatory agents.

Selective oxidative dehydrogenation of propane to propene using boron nitride catalysts.

The exothermic oxidative dehydrogenation of propane reaction to generate propene has the potential to be a game-changing technology in the chemical industry. However, even after decades of research, selectivity to propene remains too low to be commercially attractive because of overoxidation of propene to thermodynamically favored CO2 Here, we report that hexagonal boron nitride and boron nitride nanotubes exhibit unique and hitherto unanticipated catalytic properties, resulting in great selectivity to olefins. As an example, at 14% propane conversion, we obtain selectivity of 79% propene and 12% ethene, another desired alkene. Based on catalytic experiments, spectroscopic insights, and ab initio modeling, we put forward a mechanistic hypothesis in which oxygen-terminated armchair boron nitride edges are proposed to be the catalytic active sites.

[Home parenteral nutrition in Spain 2011 and 2012; a report of the home and ambulatory artificial nutrition group NADYA]. / Nutrición Parenteral Domiciliaria en España 2011 y 2012: informe del grupo de nutrición artificial domiciliaria y ambulatoria NADYA.

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. METHODOLOGY: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: Year 2010: 184 patients from 29 hospitals , representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD . During 2012, 203 patients from 29 hospitals , representing a rate of 4.39 patients/million inhabitants/year 2012 , a total of 211 episodes were recorded NPD . CONCLUSIONS: We observe an increase in registered patients with respect to previous years.Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications.

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones.

Tratamiento quirúrgico del estreñimiento infatil / Surgical treatment of childhood constipation

Solamente el 5% de los casos de estreñimiento infantil son susceptibles de tratamiento quirúrgico. El 95% son de causa funcional y se tratan con medidas conservadoras. Los que tiene causas orgánicas se pueden beneficiar de la cirugía, fisuras, fistulas, estenosis anales, hipertonía esfinteriana y sobre todo, la enfermedad de Hirschprung. Esta se caracteriza por la ausencia de elementos neuronales en la pared del recto y colon y necesita una resección de la zona aganglionica con posterior anastomosis de la zona normal al ano. La técnica quirúrgica ha evolucionad en estos últimos años y en la actualidad se prefiere utilizar la técnica de la Torre o descenso transanal en la que se extirpa el colon enfermo a través del ano sin necesidad de laparotomía. Se revisa el tratamiento empleado en 100 casos consecutivos de enfermedad de Hirschsprung operados en nuestro Servicio de Hospital La Paz entre 1990 y 2005 y sus resultados. En la actualidad la tendencia es realizar la cirugía cada vez más precoz y menos invasiva (AU)

About 95% of constipation in infancy is due to functional problems, whereas 5% of the cases are caused by organic problems, and must be treated by surgery. These case include anal fissures, phistulas, anal stenosis and Hirschsprung disease. Surgical treatment of Hirschsprung disease consists of pull through of the ganglionic colon with the resection of the aganglionic segment. The surgical technique has changed during the last five years and we currently perform the De la Torre procedure. This operation uses the transanal approach without laparotomy. One hundred consecutive cases of Hirschsprung disease were studied in our paediatric surgical service Children´s Hospital La Paz between 1990 and 2005. Nowadays we usually operate the patients earlier and with non invasive technique (AU)

Importancia de la nutrición artificial en la resolución y diagnóstico etiológico de diarrea crónica severa: a propósito de un caso / Importante of artificial nutrition in the resolution and etiologic diagnosis of severe chronic diarrhea: A propos of a case

Presentamos un caso de diarrea crónica severa, que precisa soporte nutricional parenteral, no sólo para cubrir las necesidades nutricionales sino para permitir un reposo intestinal, que permita su posterior adaptación a la nutrición enteral, permitiendo todo ello el diagnóstico etiológico de la diarrea y curación del proceso

We present a case of severe chronic diarrhea requiring parenteral nutritional support to both cover the nutritional needs and allow for intestinal rest for later adaptation to enteral nutrition, altogether allowing for the etiologic diagnosis and disease healing

[Importance of artificial nutrition in the resolution and etiologic diagnosis of severe chronic diarrhea: a propos of a case]. / Importancia de la nutrición artificial en la resolución y diagnóstico etiológico de diarrea crónica severa: a propósito de un caso.

We present a case of severe chronic diarrhea requiring parenteral nutritional support to both cover the nutritional needs and allow for intestinal rest for later adaptation to enteral nutrition, altogether allowing for the etiologic diagnosis and disease healing.

[Videothorascocopic: approach in thoracic inlet of neurogenic mediastinal tumor in pediatric age]. / Videotoracoscopia asistida: abordaje de tumor neurogénico en la encrucijada cervicotorácica en la edad pediátrica.

We present a 4 year-old patient with precedent of pneumonia and showing an increase of X-ray density in the superior mediastinal. After a year of follow-up and the presence of irritating cough, it is decided to perform studies of image (CT), being diagnosed of a mass in the region of the thoracic inlet which affects up to D4. Video-assisted thoracic surgery is decided and the mass is entirely removed, being the result of the pathological study to ganglioneuroma. Eight months later from, the patient is asymptomatic and without relapse according to the image methods which were carried out.

Resultados de efectividad de olanzapina en pacientes psicóticos agudos con agitación en servicios de urgencias: resultados del estudio NATURA / Effectiveness results of olanzapine in acute psychotic patients with agitation in the emergency room setting: results from NATURA study

Introducción. Se carece de descripciones adecuadas de los patrones de uso de antipsicóticos en urgencias. El objetivo del presente estudio es describir la efectividad y eficacia del uso de olanzapina en pacientes con psicosis aguda y agitación en urgencias. Métodos. En este estudio prospectivo observacional realizado en 16 servicios de urgencias se incluyeron 278 pacientes consecutivos con psicosis aguda y agitación, los cuales recibieron tratamiento psicofarmacológico, que incluyó olanzapina, según el criterio clínico del investigador. Se recogieron datos prospectivos de demografía, diagnóstico, medicación concomitante, utilización de contención mecánica y grado de agitación. La evolución clínica durante la estancia en urgencias se evaluó mediante la componente de excitación de la PANSS, la ICG-G y la Escala de evaluación de agitación-sedación (ACES) al ingreso, antes de cualquier reintervención (si procedió) y al alta del servicio de urgencias, evaluándose asimismo la seguridad. Resultados. Olanzapina como monoterapia se administró a 148 pacientes (53,2%), la mayoría (77,7%) con diagnóstico de esquizofrenia y psicosis relacionadas. Fueron 38(25,7%) los pacientes que precisaron contención mecánica. El cambio medio (intervalo de confianza [IC] 95 %) de basal al alta fue significativo en todas las escalas: PANSS-CE: –7,46(–8,2, –6,7); ICG-G: –1,82 (–2, –1,6); ACES: 1,28 (1,1, 1,5). Al alta, el 70,3% de los pacientes se trasladó a unidades de hospitalización. Cinco pacientes (3,4 %) presentaron acontecimientos adversos: bradicardia, boca seca, sedación, hipertensión, hipotensión e hipotensión ortostática, ninguno de los cuales fue grave. Conclusiones. La utilización de olanzapina empleada como monoterapia disminuyó la agitación en pacientes psicóticos en urgencias, con una baja incidencia de acontecimientos adversos (AU)

Introduction. Patterns of use of antipsychotics are not well described in emergency units. The objective of this study was to describe the effectiveness and safety of use of olanzapine in patients with acute psychosis and agitation in the emergency rooms. Methods. In this prospective observational study 278 patients with acute psychosis and agitation were consecutively admitted in 16 psychiatric emergency wards and treated with any oral psychopharmacology treatment, including olanzapine, according to investigators clinical criteria. Data were collected prospectively including demographics, diagnosis, concomitant medications, utilization of mechanical restraints, and severity of agitation. Clinical evolution during emergency room stay was assessed with PANSS-Excitement Component, CGI-S, and Agitation and Calmness Evaluation Scale (ACES) at baseline, before any re-intervention (if needed) and at discharge from the emergency room. Safety was also evaluated. Results. Olanzapine alone was used in 148 (53.2 %) patients. Most of them (77.7 %) were diagnosed of schizophrenia and related psychoses. Up to 38 patients (25.7 %) required mechanical restraints. Mean change (confidence interval [CI] 95%) from baseline to discharge was significant in all rating scales; PANSS-EC: –7.46 (–8.2,–6.7); CGI-S: –1.82 (–2, –1.6); ACES: 1.28 (1.1, 1.5). At discharge 70.3% of patients went to inpatient units. Five patients (3.4 %) reported adverse events including: bradycardia, dry mouth, sedation, hypertension, hypotension, and orthostatic hypotension. None of them was serious. Conclusions. The utilization of olanzapine alone decreased agitation in psychotic patients in emergency room settings. Incidence of adverse events was low and it was well tolerated (AU)

[Effectiveness results of olanzapine in acute psychotic patients with agitation in the emergency room setting: results from NATURA study]. / Resultados de efectividad de olanzapina en pacientes psicóticos agudos conagitación en servicios de urgencias: resultados del estudio NATURA.

INTRODUCTION: Patterns of use of antipsychotics are not well described in emergency units. The objective of this study was to describe the effectiveness and safety of use of olanzapine in patients with acute psychosis and agitation in the emergency rooms. METHODS: In this prospective observational study 278 patients with acute psychosis and agitation were consecutively admitted in 16 psychiatric emergency wards and treated with any oral psychopharmacology treatment, including olanzapine, according to investigators clinical criteria. Data were collected prospectively including demographics, diagnosis, concomitant medications, utilization of mechanical restraints, and severity of agitation. Clinical evolution during emergency room stay was assessed with PANSS-Excitement Component, CGI-S and Agitation and Calmness Evaluation Scale (ACES) at baseline, before any re-intervention (if needed) and at discharge from the emergency room. Safety was also evaluated. RESULTS: Olanzapine alone was used in 148 (53.2%) patients. Most of them (77.7 %) were diagnosed of Schizophrenia and related psychoses. Up to 38 patients (25.7 %) required mechanical restraints. Mean change (confidence interval [CI] 95 %) from baseline to discharge was significant in all rating scales; PANSS-EC: -7.46 (-8.2, -6.7); CGI-S: -1.82 (-2, -1.6) ACES: 1.28 (1.1, 1.5). At discharge 70.3% of patients went to inpatient units. Five patients (3.4%) reported adverse events including: bradycardia, dry mouth, sedation, hypertension, hypotension, and orthostatic hypotension. None of them was serious. CONCLUSIONS: The utilization of olanzapine alone decreased agitation in psychotic patients in emergency room settings. Incidence of adverse events was low and it was well tolerated.

Videotoracoscopia asistida: abordaje de tumor neurogénico en la encrucijada cervicotorácica en la edad pediátrica / Videothorascocopic: approach in thoracic inlet of neurogenic mediastinal tumor in pediatric age

Presentamos un paciente de 4 años de edad con antecedente de neumonía con el diagnóstico, por radiología convencional, de un aumento de densidad del mediastino superior. Tras un año de seguimiento y aparición de tos irritativa se decide realizar estudios de imagen, diagnosticándose mediante TAC un tumor en la región de la encrucijada cervicotorácica que afecta hasta D4.Se decide realizar planteamiento quirúrgico mediante videotoracoscopia asistida. El tumor es extirpado en su totalidad, siendo el diagnóstico anatomo-patológico de ganglio neuroma. El paciente a los 8meses de la intervención se encuentra asintomático y sin recidiva según los métodos de imagen realizados (AU)

We present a 4 year-old patient with precedent of pneumonia and showing an increase of X-ray density in the superior mediastinal. After a year of follow-up and the presence of irritating cough, it is decided to perform studies of image (CT), being diagnosed of a mass in the region of the thoracic inlet which affects up to D4.Video-assisted thoracic surgery is decided and the mass is entirely removed, being the result of the pathological study to ganglioneuroma. Eight months later from, the patient is asymptomatic and without relapse according to the image methods which were carried out (AU)

[New concepts in the natural history of multicystic dysplastic kidney]. / Nuevos conceptos en la historia natural de la displasia renal multiquística.

OBJECTIVE: Retroperitoneoscopy has shown that US involution is not synonymous with complete regression of the dysplastic renal parenchyma in US-involuted multicystic dysplastic kidney (MCDK). The objective is to analyze the meaning of this results. PATIENTS AND METHODS: 16 patients (nine girls and seven boys) with unilateral MCDK that showed complete involution on ultrasonography, underwent prospectively a retroperitoneoscopic approach. US showed complete cysts involution at the mean age of 10 months (ranging from five to 22 months). All patients underwent a retroperitoneoscopic approach after US involution of the MCDK. The mean age of retroperitoneoscopy was 36 months (ranging from eight to 56 months). RESULTS: The retroperitoneoscopic approach revealed persistence of dysplastic renal tissue in 100% of the patients. The mean lenght of the renal renmant was 2 cm (ranging from 1 and 3.5 cm). All patients had a mean length of stay of less than 24 hours. Anatomo-pathological study of the samples showed a wide spectrum of dysplastic renal tissue and the absence of preneoplastic cells. CONCLUSIONS: Ultrasonography is our method of choice to follow up MCDK until cyst involution takes place. The presence of a dysplastic renal remnant which is not visible on US, requires an appropriate long-term follow up to screen for the growth of tumors. In our experience, retroperitoneoscopy allows the diagnosis and treatment of the displastic renal renmant in the same minimally invasive ambulatory procedure, avoiding long-term development of tumors. Overall, it is our responsibility to sufficiently inform to the family about the persistence of dysplastic renal remnant to facilitate their decision about the best treatment for their child.

[Congenital cystic adenomatoid malformation: prenatal diagnosis, surgical treatment results and long-term follow-up]. / Malformación adenomatoidea quística: diagnóstico prenatal, resultados de la cirugía y seguimiento a largo plazo.

PURPOSE: (PD), possibility of regresion and hidden mortality are open questions in congenital cystic adenomatoid malformation (CCAM) treatment. METHODS: Children with CCAM were reviewed focused on: PD, postnatal diagnosis, clinic, radiology, histology and evolution. RESULTS: Seventeen fetus had PD of CCAM. Five gestations were electively finished (41%) with PD of CCAM previous to 20th week, 3/5 (60%) were type III and 2/5 (40%) type I; 4/5 (80%) presented mediastinal shift and 1/5 (20%) hidrops. Two fetuses (11%) suffered fetal demise in 20th and 32th week; 1 type 1 and 1 type III; 1/2 (50%) presented hidrops and 2/2 (100%) mediastinal shift. Two (12%) died before 24 hours after birth without intervention possibility due to respiratory instability, 1 type II and 1 type III, both with mediastinal shift (100%). In one fetus with a type III malformation the image disappeared completely in 32th week and no intervention was done. Fourteen patients were operated (8 girls and 6 boys); 7/14 (50%) had PD, average diagnosis week was 21.9 (range 19.1-35.5), 5/7 (71%) was type I, 1/7 (14%) type II and 1/7 (14%) type III. None had mediastinal shift or hidrops. Average postnatal diagnosis week was 7 months (range 0.1-29). In 10/14 (71.4%) there were not respiratory difficulty during neonatal period and 3/10 (30%) suffered respiratory infections afterwards. Average week of operation was 8 months (range 0.1-30). PD was according with histology in 6/7 (86%) patients. After an average follow-up period of 4.3 years (range 1-9.5) the only complication is a pectus excavatum. CONCLUSIONS: More than half of patients with PD of CCAM died without intervention. Half of cases of CCAM are diagnosed prenatally. Type of CCAM in PD is according to histology in 86% of the cases. Fetuses with hidrops present a worse prognosis. Surgical timing do not seem to influence on outcome.

[Retroperitoneoscopic assisted pyeloplasty for ureteropelvic junction obstruction in children]. / Pieloplastia asistida por retroperitoneoscopia: nuestra experiencia en 30 pacientes.

OBJECTIVES: Description of the retroperitoneoscopic approach in the conventional pyeloplasty for ureteropelvic junction obstruction in children. MATERIAL AND METHODS: From 1998 pyeloplasty assisted by retroperitoneoscopic approach (PARA) was performed in 30 patients. TECHNIQUE: Position in latero-dorsal decubitus and incision of 1 cm in angle costolumbar. We made retroperitoneoscopic space by ball dissection technique and 11 mm Hg pressure. The ureteropelvic junction was extracted through the incision of the port. The UPJ was resected in all patients and Anderson-Hynes pyeloplasty with double PDS 6/0 continuous sutures was performed. In all patients a drainage type Penrose in perirenal space was used. In the last 18 patients a 4F double-J stent was placed. The mean follow-up time was 42 months (range between 6 and 84 months). Operative time, hospital stay, handling of postoperative pain and the postoperative studies have been revised. RESULTS: In all the cases the retroperitoneoscopic approach was good for the identification and dissection of the ureteropelvic junction facilitating the extraction and reconstruction (pyeloplasty) through the mini-incision of the entrance port. The mean operative time was 90 min. (range between 65 and 128 min). We highlight the absence of intraoperative complications. The only postoperative complication has been a pyohydronephrosis in a patient not having internal drainage that was solved by percutaneous pyelostomy and didn't need reintervention. The postoperative handling of the pain was good by means of caudal locorregional anesthesia or by infiltration of the wound with local anesthesic and a dose of Ibuprofeno previous to leave the hospital. The mean hospital stay was 2 days (1-3 days) excluding the complicated case. Postoperative diuretic renograms at the 6 and 18 have shown absence of obstruction in all cases. In the long term follow-up, in 1 case nephrectomy was performed. CONCLUSIONS: The PARA for UPJ obstruction is a safe and effective procedure with the advantage of a minimal invasive approach that facilitates the reconstruction of the ureteropielic junction. Reduces operative time and hospital stay, with appropriate postoperative results. In our experience PARA constitutes an alternative to the conventional pyeloplasty and laparoscopic pyeloplasty in the pediatric age.

Nuevos conceptos en la historia natural de la displasia renal multiquística / New concepts in the natural history of multicystic dysplastic kidney

Objetivo. La retroperitoneoscopia ha demostrado que en la DRM involucionada ecográficamente, los quistes desaparecen pero el tejido renal displásico permanece. El objetivo de este trabajo es analizar la repercusión que estos hallazgos tienen sobre el tratamiento y seguimiento a largo plazo de los niños portadores de DRM involucionada. Material y métodos. Los hallazgos están basados en el estudio prospectivo de 16 pacientes, 9 niñas y 7 niños, portadores de DRM unilateral, 11 de afectación izquierda y 5 derecha, que habían sufrido completa involución de la DRM en el estudio ecográfico seriado. La edad media de desaparición de los quistes renales fue de 10 meses (rango entre 5 y 22 meses). En todos los pacientes se realizó un abordaje retroperitoneoscópico para confirmar la persistencia o no de un remanente displásico renal. La edad media del abordaje retroperitoneoscópico fue de 36 meses (rango entre 8 y 56 meses). Resultados. La retroperitoneoscopia detectó persistencia de tejido renal displásico en el 100% de los casos. El tamaño medio del remanente renal fue de 2 cm (rango entre 1 y 3,5 cm). En todos los casos se realizó la extirpación del remanente renal displásico (nefrectomía retroperitoneoscópica). Los hallazgos anatomopatológicos en todas las muestras confirmaron la existencia de displasia renal. La estancia media hospitalaria fue inferior a 24 horas en todos los casos. Todos los niños fueron dados de alta definitiva al mes postoperatorio, no siendo necesario el seguimiento a largo plazo. Conclusiones. La ecografía no es útil en el seguimiento de la DRM involucionada. La persistencia del remanente displásico no visible en la ecografía obliga al despistaje de tumores a largo plazo mediante ecografías seriadas frecuentes. Por ello, cuando los quistes desaparecen, consideramos a la retroperitoneoscopia el método de elección, mínimamente invasivo, para el diagnóstico del remanente displásico renal en la DRM involucionada, que permite su tratamiento en el mismo acto quirúrgico sin alargar la estancia hospitalaria. Este abordaje evita la necesidad de seguimiento a largo plazo para el despistaje de tumores, reduciendo la ansiedad de la familia y la necesidad de revisión del niño por el especialista (AU)

OBJECTIVE: Retroperitoneoscopy has shown that US involution is not synonymous with complete regression of the dysplastic renal parenchyma in US-involuted multicystic dysplastic kidney (MCDK).The objective is to analyze the meaning of this results. PATIENTS AND METHODS: 16 patients (nine girls and seven boys) with unilateral MCDK that showed complete involution on ultrasonography, underwent prospectively a retroperitoneoscopic approach. US showed complete cysts involution at the mean age of 10 months (ranging from five to 22 months). All patients underwent a retroperitoneoscopic approach after US involution of the MCDK. The mean age of retroperitoneoscopy was 36 months (ranging from eight to 56 months). RESULTS: The retroperitoneoscopic approach revealed persistence of dysplastic renal tissue in 100% of the patients. The mean lenght of the renal renmant was 2 cm (ranging from 1 and 3.5 cm). All patients had a mean length of stay of less than 24 hours. Anatomo-pathological study of the samples showed a wide spectrum of dysplastic renal tissue and the absence of preneoplastic cells. CONCLUSIONS: Ultrasonography is our method of choice to follow up MCDK until cyst involution takes place. The presence of a dysplastic renal remnant which is not visible on US, requires an appropriate long-term follow up to screen for the growth of tumors. In our experience, retroperitoneoscopy allows the diagnosis and treatment of the displastic renal renmant in the same minimally invasive ambulatory procedure, avoiding long-term development of tumors. Overall, it is our responsibility to sufficiently inform to the family about the persistence of dysplastic renal remnant to facilitate their decision about the best treatment for their child (AU)

Malformación adenomatoidea quística: diagnóstico prenatal, resultados de la cirugía y seguimiento a largo plazo / Congenital cystic adenomatoid malformation: prenatal diagnosis surgical treatment results and long-term follow-up

Introducción. El diagnóstico prenatal (DP) posibilidad de regresión, mortalidad oculta y momento de la cirugía son cuestiones abiertas en el seguimiento de niños con malformación adenomatoidea quística (MAQ). Pacientes y métodos. Revisamos en las historias de niños con MAQ entre los años 1995 y 2005: diagnóstico prenatal y posnatal, presentación clínica y radiológica, intervención quirúrgica, histología y evolución. Resultados. Diecisiete fetos tenían DP de MAQ. Cinco (41%) se abortaron de manera electiva con DP previo a la semana 20, 3/5 (60%) fueron tipo III y 2/5 (40%) tipo I; 4/5 (80%) presentaban desplazamiento cardíaco y 1/5 (20%) anasarca y ascitis. Dos (11%) fueron abortos espontáneos con DP en las semanas 20 y 32; 1 tipo I y 1 tipo III; 1/2 (50%) presentaba hidrops y 2/2 (100%) desplazamiento cardíaco. Dos (12%) murieron antes de las 24 horas de vida sin posibilidad de intervención por inestabilidad, 1 tipo II y 1 tipo III, ambos con desplazamiento cardíaco (100%). En 1 (6%) con DP de MAQ tipo III en la semana 20 desapareció la imagen en la semana 32; no fue intervenido y está asintomático. Catorce pacientes fueron intervenidos (8 niñas y 6 niños); 7/14 (50%) tenían DP, la semana media de diagnóstico fue 21,9 (rango 19,1- 35,5), 5/7 (71%) fueron tipo I, 1/7 (14%) tipo II y 1/7 (14%) tipo III. Ninguno tenía desplazamiento cardíaco o hidrops. La mediana de edad de diagnóstico posnatal fue 7 meses (rango 0,1-29). En 10/14 (71,4%) no existió dificultad respiratoria en el período neonatal desarrollando 3/10 (30%) infección posteriormente. La mediana de edad de la intervención quirúrgica fue 8 meses (rango 0,1-30). En 11/13 (84%) casos se hizo lobectomía y en 2 (16%) lobectomía acompañada de segmentectomía. En 1 caso sin lesiones radiológicas posnatales se hizo exploración quirúrgica sin resección. El resultado histológico fue MAQ tipo I 9/13 (69%), tipo II 1/13 (7,6%) y tipo III 3/13 (23%). El DP se correspondía con el histológico en 6/7 (86%) pacientes. Tras un seguimiento medio de 4.3 años (rango 1-9,5) la única complicación es un pectus leve. Conclusiones. Más de la mitad (52%) de los niños con DP de MAQ mueren sin ser intervenidos. El DP diagnostica MAQ en la mitad de los casos y el tipo de MAQ en el 86% de éstos. En el DP el desplazamiento cardíaco y el hidrops se asocian a una alta mortalidad por aborto espontáneo o en el período neonatal inmediato siendo estos pacientes susceptibles de cirugía fetal. El pronóstico de los niños intervenidos sin DP o con DP sin hidrops, anasarca o ascitis es excelente. No hemos encontrado cambios en la evolución relacionados con el tipo de resección o el momento de ésta (AU)

PURPOSE: (PD), possibility of regresion and hidden mortality are open questions in congenital cystic adenomatoid malformation (CCAM) treatment. METHODS: Children with CCAM were reviewed focused on: PD, postnatal diagnosis, clinic, radiology, histology and evolution. RESULTS: Seventeen fetus had PD of CCAM. Five gestations were electively finished (41%) with PD of CCAM previous to 20th week, 3/5 (60%) were type III and 2/5 (40%) type I; 4/5 (80%) presented mediastinal shift and 1/5 (20%) hidrops. Two fetuses (11%) suffered fetal demise in 20th and 32th week; 1 type 1 and 1 type III; 1/2 (50%) presented hidrops and 2/2 (100%) mediastinal shift. Two (12%) died before 24 hours after birth without intervention possibility due to respiratory instability, 1 type II and 1 type III, both with mediastinal shift (100%). In one fetus with a type III malformation the image disappeared completely in 32th week and no intervention was done. Fourteen patients were operated (8 girls and 6 boys); 7/14 (50%) had PD, average diagnosis week was 21.9 (range 19.1-35.5), 5/7 (71%) was type I, 1/7 (14%) type II and 1/7 (14%) type III. None had mediastinal shift or hidrops. Average postnatal diagnosis week was 7 months (range 0.1-29). In 10/14 (71.4%) there were not respiratory difficulty during neonatal period and 3/10 (30%) suffered respiratory infections afterwards. Average week of operation was 8 months (range 0.1-30). PD was according with histology in 6/7 (86%) patients. After an average follow-up period of 4.3 years (range 1-9.5) the only complication is a pectus excavatum. CONCLUSIONS: More than half of patients with PD of CCAM died without intervention. Half of cases of CCAM are diagnosed prenatally. Type of CCAM in PD is according to histology in 86% of the cases. Fetuses with hidrops present a worse prognosis. Surgical timing do not seem to influence on outcome (AU)

Pieloplastia asistida por retroperitoneoscopia: nuestra experiencia en 30 pacientes / Retropenitoneoscopic assisted pyeloplasty for ureteropelvic junction obstruction in children

Objetivos. Descripción del abordaje retroperitoneoscópico en la pieloplastia convencional para la obstrucción de la unión pieloureteral en niños. Material y métodos. Desde 1998 hemos realizado pieloplastia asistida por retroperitoneoscopia (PAR) en 30 pacientes. Técnica. Posición en decúbito lateroposterior e incisión de 1 cm en ángulo costolumbar. Creación de espacio retroperitoneoscópico con balón de disección neumática y mantenimiento del mismo mediante retroneumoperitoneo de hasta 11 mmHg. Exteriorización de la unión pieloureteral a través de la incisión del puerto de entrada. Ureteropieloplastia mediante neoanastomosis con doble sutura continua de PDS 6/0 y magnificación. Drenaje tipo Penrose en lecho peri renal. En los últimos 18 pacientes se tutorizó la neounión mediante drenaje interno doble J. El seguimiento medio ha sido de 42 meses (rango entre 6 y 84 meses). Se ha revisado: el tiempo operatorio, la estancia hospitalaria, el manejo de dolor postoperatorio y los estudios postoperatorios de seguimiento renográfico. Resultados. En todos los casos, el abordaje retroperitoneoscópico fue óptimo para la identificación y disección de la unión pieloureteral facilitando la extracción y reconstrucción (pieloplastia) a través de la miniincisión del puerto de entrada. El tiempo medio de la cirugía ha sido de 90 min (rango entre 65 y 128 min). Destacamos la ausencia de complicaciones intraoperatorias. La única complicación postoperatoria de la serie ha sido un episodio de pielohidronefrosis, en un paciente no portador de drenaje interno, que se solucionó mediante pielostomía percutánea y que no precisó reintervención. El manejo postoperatorio del dolor fue óptimo mediante anestesia locorregional caudal o infiltración de la herida quirúrgica con anestésico local y una dosis de ibuprofeno oral intrahospitalario. La estancia media ha sido de 2 días (rango entre 1 y 3 días) excluyendo el caso complicado. Los controles postoperatorios mediante renograma diurético a los 6 y 18 meses de la cirugía han mostrado ausencia de obstrucción en todos los casos. En el seguimiento a largo plazo fue necesario realizar nefrectomía en 1 caso. Conclusiones. La pieloplastia asistida por retroperitoneoscopia ha demostrado ser una técnica de abordaje mínimamente invasiva que facilita la cirugía reconstructiva de la unión pieloureteral, que reduce el tiempo operatorio y la estancia hospitalaria, con resultados postoperatorios adecuados. La PAR constituye una alternativa a la pieloplastia convencional y a la pieloplastia laparoscópica en el tratamiento de la hidronefrosis en la edad pediátrica (AU)

OBJECTIVES: Description of the retroperitoneoscopic approach in the conventional pyeloplasty for ureteropelvic junction obstruction in children. MATERIAL AND METHODS: From 1998 pyeloplasty assisted by retroperitoneoscopic approach (PARA) was performed in 30 patients. Technique: Position in latero-dorsal decubitus and incision of 1 cm in angle costolumbar. We made retroperitoneoscopic space by ball dissection technique and 11 mm Hg pressure. The ureteropelvic junction was extracted through the incision of the port. The UPJ was resected in all patients and Anderson-Hynes pyeloplasty with double PDS 6/0 continuous sutures was performed. In all patients a drainage type Penrose in perirenal space was used. In the last 18 patients a 4F double-J stent was placed. The mean follow-up time was 42 months (range between 6 and 84 months). Operative time, hospital stay, handling of postoperative pain and the postoperative studies have been revised. RESULTS: In all the cases the retroperitoneoscopic approach was good for the identification and dissection of the ureteropelvic junction facilitating the extraction and reconstruction (pyeloplasty) through the mini-incision of the entrance port. The mean operative time was 90 min. (range between 65 and 128 min). We highlight the absence of intraoperative complications. The only postoperative complication has been a pyohydronephrosis in a patient not having internal drainage that was solved by percutaneous pyelostomy and didn't need reintervention. The postoperative handling of the pain was good by means of caudal locorregional anesthesia or by infiltration of the wound with local anesthesic and a dose of Ibuprofeno previous to leave the hospital. The mean hospital stay was 2 days (1-3 days) excluding the complicated case. Postoperative diuretic renograms at the 6 and 18 have shown absence of obstruction in all cases. In the long term follow-up, in 1 case nephrectomy was performed. CONCLUSIONS: The PARA for UPJ obstruction is a safe and effective procedure with the advantage of a minimal invasive approach that facilitates the reconstruction of the ureteropielic junction. Reduces operative time and hospital stay, with appropriate postoperative results. In our experience PARA constitutes an alternative to the conventional pyeloplasty and laparoscopic pyeloplasty in the pediatric age (AU)

Does the multicystic dysplastic kidney really involute? The role of the retroperitoneoscopic approach.

OBJECTIVE: To assess the role of video-assisted retroperitoneoscopy in the follow up of multicystic dysplastic kidney (MCDK) that has involuted--disappeared?--on serial renal ultrasonography (US). PATIENTS AND METHODS: Prospectively, we performed a retroperitoneoscopy in 14 patients, nine girls and five boys, with unilateral MCDK that had involuted on serial US. MCDK was diagnosed in utero (80%) and confirmed postnatally by US and Tc99m dimercaptosuccinic acid radionuclide scan. Follow up US examinations were performed at 1 month, 5 months and 12 months in the first year of life and every 6 months from then on. US showed complete involution at a mean age of 13 months (range 5-18 months). Retroperitoneoscopy was then indicated, at a mean age of 23 months (range 8-24 months), to confirm the disappearance of the kidney dysplastic remnant. RESULTS: Retroperitoneoscopy detected persistence of anomalous kidney tissue in 100% of cases. The mean length of the renal remnant was 2 cm (range 1-3.5 cm). Two cases showed a pelvic ectopic location that was not detected by US before involution. The remnant was removed during the same procedure. Anatomo-pathological findings were found to be compatible with dysplastic renal tissue. There were no intra- or postoperative complications. All patients had a mean length of stay of less than 24h. CONCLUSIONS: Complete resolution on US does not mean disappearance of MCDK, as US does not detect renal dysplastic remnants after cyst involution has occurred. The retroperitoneoscopic approach to the renal and pelvic area is a minimally invasive, safe and effective procedure to diagnose and treat the renal dysplastic remnant in US-involuted MCDK.

[Retroperitoneoscopic nephrectomy: our experience in short-term hospital stay]. / Nefrectomía retroperitoneoscópica. Nuestra experiencia con ingreso en hospital de corta estancia.

OBJECTIVE: To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. MATERIAL AND METHODS: From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney's functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). RESULTS: In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. CONCLUSIONS: The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stayis lesser when the nephrectomy was performed by retro peritoneal approach than conventional surgery. Consequently this procedure can be carry out in a short hospital stay.

Nefrectomía retroperitoneoscópica. Nuestra experiencia con ingreso en Hospital de Corta Estancia / Retroperitoneoscopic nephrectomy: our experience in sort hospital stay

Objetivos. Demostrar que la nefrectomía, a pesar de ser un procedimiento de cirugía mayor, requiere una estancia hospitalaria menor de 48 horas, siempre que se realice mediante abordaje retroperitoneal laparoscópico. Consecuentemente este procedimiento puede ser realizado en el Hospital de Corta Estancia. Material y métodos. Desde 1995 hemos tratado 40 pacientes mediante nefrectomía retroperitoneoscópica con un total de 46 nefrectomías. En 6 pacientes fueron bilaterales por insuficiencia renal terminal (IRT), y por lo tanto no están reflejadas en este estudio. La edad media fue de 4,8 años (rango entre 6 meses y 13 años), con relación al sexo: varones (n=16) y hembras (n=18). En cuanto al lado de la nefrectomía fue derecho en 20 e izquierdo en 14. Las patologías que indicaron nefrectomía(n=34) por anulación funcional del riñón fueron: hidronefrosis obstructiva (n=2); megauréter obstructivo (n=1); nefropatía por reflujo vesicoureteral (n=8); displasia renal multiquística (n=11); riñón multiquístico desaparecido (n=12). Resultados. En todos los casos la nefrectomía fue retroperitoneal pura. El tiempo de duración quirúrgico medio fue de 92 min (rango de 60- 240 min). Se reconvirtió en 1 caso (4,5%) por microperforación peritoneal (n=1). Destacamos la ausencia de complicaciones inherentes al procedimiento retroperitoneoscópico intraoperatorio y postoperatorio. Como complicaciones secundarias al procedimiento quirúrgico se presentaron dos relajaciones de pared en herida incisional y un seroma de puerto de entrada. El sangrado durante el acto operatorio fue inapreciable, menor de 20 cc. No se dejaron drenajes en el lecho operatorio. La estancia media ha sido reducida a 27 horas, no siendo contabilizados los 6 casos de IRT. En los 18 últimos casos, el alta hospitalaria fue dada en las primeras 24 horas postoperatorias. La analgesia establecida por protocolo ha sido infiltración de puertos con bupivacaína 1% y una dosis de paracetamol/ibuprofeno a las 12 horas de la intervención, repetida al alta hospitalaria. La incorporación a su vida cotidiana –domicilio y escuela– ha sido precoz en el 100% de los casos. Destacamos la ausencia de complicaciones secundarias al dolor (respiratorias) y a la inmovilización. Conclusiones. La nefrectomía retroperitoneoscópica es una indicación claramente establecida y de obligada realización en la edad pediátrica. Es el abordaje quirúrgico idóneo para realizar una nefrectomía por su fiabilidad, reproducibilidad y seguridad. La estancia media se ha reducido con respecto a la cirugía convencional pudiéndose realizar en Hospital de Corta Estancia (AU)

Objective. To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. Material and methods. From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney’s functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). Results. In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. Conclusions. The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stay is lesser when the nephrectomy was performed by retro peritoneal approach than conventional surgery. Consequently this procedure can be carry out in a short hospital stay Objective. To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. Material and methods. From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney’s functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). Results. In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. Conclusions. The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stay is lesser when the nephrectomy was performed by retro peritoneal approach than conventionalsurgery. Consequently this procedure can be carry out in a short hospital stay (AU)

Double-blind olanzapine vs. haloperidol D2 dopamine receptor blockade in schizophrenic patients: a baseline-endpoint.

The aim of this study was to compare in vivo striatal D2 dopamine receptor occupancy induced by olanzapine and haloperidol in schizophrenic patients using a baseline-endpoint [(123)I]IBZM single photon computed emission tomography (SPECT) design. The relationships of striatal D2 receptor occupancy with clinical efficacy and extrapyramidal symptoms (EPS) were also assessed. Twenty-seven inpatients with schizophrenia or schizophreniform disorder were included in a 4-week prospective, randomized, double-blind, parallel and comparative clinical trial. Thirteen patients were treated with haloperidol (10 mg/day) and 14 with olanzapine (10 mg/day). Ratings of clinical status and EPS were obtained weekly. The percentage of D2 receptor occupancy was estimated by using basal ganglia (striatum)/frontal cortex IBZM uptake ratios obtained from each patient before and after 4 weeks of maintained antipsychotic treatment. Olanzapine led to a mean striatal D2 receptor occupancy of 49% (range 28-69%), which was significantly lower than that induced by haloperidol (mean 64%, range 46-90%). The baseline-endpoint SPECT design used in this study revealed lower antipsychotic D2 occupancy percentage values than those reported in the literature, using other approaches. The degree of striatal D2 receptor occupancy correlated to the EPS, which predominantly appeared in patients on haloperidol. No relationship was found between the striatal D2 receptor occupancy and clinical improvement. Olanzapine induced a lower striatal D2 occupancy than haloperidol. This low striatal D2 occupancy, together with the lower incidence of EPS in olanzapine-treated patients, contributed to confirm the atypical behavior of this new antipsychotic drug. Nevertheless, conclusions based on SPECT-estimated percentages of antipsychotic D2 occupancy should be cautious, since the SPECT design could influence the results. In this regard, SPECT studies including baseline and endpoint examinations should be encouraged.