Efficacy of an aloe vera, chamomile, and thyme cosmetic cream for the prophylaxis and treatment of mild dermatitis induced by radiation therapy in breast cancer patients (the Alantel study).

Objectives: Radiation-induced dermatitis (RD) is one of the most common toxicities in radiation therapy (RT) patients. Corticosteroids, immunosuppressants, and natural products (NPs) have been used as treatment. The objective was to evaluate the efficacy of a NPs-based cream (Alantel®) to reduce the incidence of RD in women with breast cancer undergoing RT treatment. Design: We conducted a controlled, randomized, double-blind clinical trial. Setting: Radiation Oncology Unit of the Reina Sofía Hospital and 5 Primary Care centers of the Cordoba and Guadalquivir Health District (Spain). Interventions: Patients assigned to the experimental group (GTA) were treated with Alantel, while those in the control group (GTE) were treated with a moisturizer and emollient cream. Main outcome measures: The primary outcome variable was the incidence of RD. RD-free time, duration of RD, quality of life, and product safety were also assessed. Results: Seventy patients were included in the study, 35 in the GTA and 35 in the GTE. The incidence of RD was lower in the GTA (71.4%) than in the GTE (91.4%) after 4 weeks of follow-up (RR = 0.78; NNT = 5; p < 0.031). The Skindex-29 questionnaire showed differences in the statement: "My skin condition makes it hard to work or do hobbies" (17.1% in the GTE vs. 2.9% in GTA; p = 0.024). Conclusions: The higher efficacy of Alantel® compared to the control cream in reducing the incidence of RD in women with breast cancer has been demonstrated.

Prevalencia de la litiasis renal en Andalucía: resultados del estudio PreLiRenA / Prevalence of Renal Stones in Andalusian Population: Results of PreLiRenA Study

Introducción: La urolitiasis es una enfermedad con alta tasa de recidiva y gran morbilidad asociada. Se está percibiendo un aumento no bien cuantificado en los últimos años que podría estar relacionado con diversos factores. El objetivo principal fue estimar la magnitud de la urolitiasis en Andalucía y determinar qué factores se hallan asociados. Material y métodos: Realizamos un estudio observacional, transversal. Mediante procedimiento aleatorizado polietápico seleccionamos una muestra de 2.439 sujetos, de 40 a 65 años, residentes en Andalucía. La recogida de datos se realizó mediante encuesta telefónica, interrogando a los sujetos sobre antecedentes de litiasis renal, comorbilidad y características sociodemográficas. Realizamos un análisis estadístico descriptivo, bivariado y multivariado (regresión logística múltiple). Resultados: Fueron encuestados 2.439 sujetos, con una edad media de 51,1 ± 7,61 años-desviación típica (intervalo de confianza al 95% [IC 95%]: 50,70-51,30) de los cuales el 48,7% eran varones. La prevalencia de urolitiasis fue del 16,4% (IC 95%:14,87-17,85) y la incidencia del 1,2% (IC 95%: 0,74-1,64). Como variables asociadas a la presencia de urolitiasis en el estudio multivariado encontramos la presencia de antecedentes familiares de litiasis renal (odds ratio [OR]: 1,91; IC 95%:1,51-2,40; p < 0,001); la hipertensión arterial (OR: 1,58; IC 95%: 1,24-2,02; p < 0,001), padecer gota (OR: 1,98; IC 95%: 1,26-3,12; p = 0,003) y un índice de masa corporal elevado (OR: 1,60; IC 95%:1,19-2,17; p = 0,008). Conclusiones: Se constata un incremento importante de la prevalencia e incidencia de urolitiasis en nuestro medio con respecto a las cifras que previamente conocíamos. La presencia de antecedentes familiares de urolitiasis, la hipertensión arterial, la gota, unido a un índice de masa corporal elevado, podrían desempeñar un importante papel en los cambios epidemiológicos observados en la litiasis renal

Introduction: Urolithiasis is a disease having a high recurrence rate and associated morbidity. A not well quantified increase is being seen in recent years that could be related with various factors. The main purpose of our study has been to estimate urolithiasis prevalence and incidence in the region of Andalusia, determining which factors are associated. Material and methods: We performed an observational and cross-sectional study. Using a multistage randomized procedure, we selected a sample of 2439 subjects, aging from 40 to 65 years old, who currently lived in Andalusia. Data was collected through phone interviews, questioning the chosen subjects about their kidney stones history, comorbidity and socio-demographic characteristics. We conducted a descriptive, bivariate and multivariate analysis with logistic regression. esults: A total of 2439 subjects were surveyed. Subjects had mean age of 51.1 ± 7.61 years -standard deviation; (95% confidence interval–95% CI: 50.70-51.30), 48.7% of whom were male. Prevalence of urolithiasis obtained was 16.4% (95% CI: 14.87-17.85%) and an incidence of 1.2 (95% CI: .74-1.64). Variables significantly associated with the presence of urolithiasis found in the multivariate study were: presence of a family history of kidney stones (odds ratio -OR: 1.91; 95% CI: 1.51-2.40, P < .001), hypertension (OR:1.58; 95% CI:1.24-2.02; P < .001), gout (OR:1.98; 95% CI: 1.26-3,12; P = .003) and a high BMI (OR: 1.60; 95% CI 1.19-2.17; p = .008). Conclusions: A significant increase in the prevalence and incidence of urolithiasis is observed in the environment in regards to the previously available figures. The presence of a family history of urolithiasis, hypertension, gout as well as having a high BMI could influence the observed epidemiological changes in renal lithiasis

Prevalence of renal stones in Andalusian population: results of PreLiRenA study.

INTRODUCTION: Urolithiasis is a disease having a high recurrence rate and associated morbidity. A not well quantified increase is being seen in recent years that could be related with various factors. The main purpose of our study has been to estimate urolithiasis prevalence and incidence in the region of Andalusia, determining which factors are associated. MATERIAL AND METHODS: We performed an observational and cross-sectional study. Using a multistage randomized procedure, we selected a sample of 2439 subjects, aging from 40 to 65 years old, who currently lived in Andalusia. Data was collected through phone interviews, questioning the chosen subjects about their kidney stones history, comorbidity and socio-demographic characteristics. We conducted a descriptive, bivariate and multivariate analysis with logistic regression. RESULTS: A total of 2439 subjects were surveyed. Subjects had mean age of 51.1±7.61 years - standard deviation; (95% confidence interval - 95% CI: 50.70-51.30), 48.7% of whom were male. Prevalence of urolithiasis obtained was 16.4% (95% CI: 14.87-17.85%) and an incidence of 1.2 (95% CI: .74-1.64). Variables significantly associated with the presence of urolithiasis found in the multivariate study were: presence of a family history of kidney stones (odds ratio -OR: 1.91; 95% CI: 1.51-2.40, P<.001), hypertension (OR:1.58; 95% CI:1.24-2.02; P<.001), gout (OR:1.98; 95% CI: 1.26-3,12; P=.003) and a high BMI (OR: 1.60; 95% CI 1.19-2.17; p=.008). CONCLUSIONS: A significant increase in the prevalence and incidence of urolithiasis is observed in the environment in regards to the previously available figures. The presence of a family history of urolithiasis, hypertension, gout as well as having a high BMI could influence the observed epidemiological changes in renal lithiasis.

Percepción de los pacientes sobre la atención recibida por el personal no sanitario en los centros de salud / Patients’ perception on attention received from Health Centres non-sanitary staff

Objetivos. Conocer la percepción que tienen los usuarios sobre algunos aspectos interpersonales y técnicos relacionados con la atención que reciben del personal de atención al ciudadano cuando acuden a los centros de atención primaria. Valorar la posible utilidad de dos modos de medición de la satisfacción. Material y métodos. Estudio observacional descriptivo realizado con usuarios que utilizaron los servicios de atención al ciudadano de los centros de salud. Tras consultar con este personal, los usuarios fueron entrevistados personalmente utilizando dos tipos de preguntas que evaluaron sus opiniones y satisfacción con diferentes aspectos comunicacionales y de tipo técnico relacionados con la demanda realizada. Las preguntas abiertas fueron agrupadas en categorías en un proceso que involucró a tres investigadores de manera independiente. Se realizó un análisis descriptivo e inferencial (test de la X2, p<0,05). Resultados. Más de un 90% (360) de los usuarios encuestados declararon estar satisfechos o muy satisfechos con la atención recibida en atención al ciudadano; sin embargo, entre el 18 y el 36% hicieron sugerencias para mejorar esta atención tras su consulta. Independientemente del dominio explorado, destacaron las sugerencias referidas a la relación/comunicación, capacitación del personal para resolver los problemas, calidad y cantidad de las explicaciones y tiempo de espera. Conclusiones. Las encuestas que incorporan preguntas abiertas parecen más útiles para valorar la calidad de la atención recibida de los administrativos de los centros de salud, detectar problemas en esta atención y planificar nuevas intervenciones de mejora. Los aspectos relacionales e informativos representan un área de mejora prioritaria en este ámbito(AU)

Aims. To know patients’ perceptions about relational aspects and technical procedures when they are attended by the administrative staff in Health Centres. To assess the utility of two ways for measuring satisfaction. Material and methods. Cross-sectional study carried out in people attending the administrative sections of Health Centres for diverse reasons. Just after the interaction with the administrative they were interviewed using two different questions for assessing their opinions and satisfaction with communicational and technical aspects related with their demands. Descriptive analysis. Significant differences among mean was explored by X2 test. Open-ended questions were grouped in categories in a process involving three researchers independently. Results. Over than 90% (360) of the attendees declared to be satisfied or very satisfied with the service received from the staff personal. Nevertheless, among 18-36% gave suggestions for improving the service after their consultation. Independently the domain explored, people suggested the communicational, personal capability, quality and quantity of explanations and waiting time as the main aspects to be improved. Conclusions. Surveys with open-ended questions are more useful to assess the quality of the attention the citizens receive from no-sanitary staff in Health Centres. These type of questions are also more useful for detecting problems and planning new interventions. Relational and informative issues seem to be the most prioritary areas to improve in this section of Health Centres(AU)

[Patients' perception on attention received from Health Centres non-sanitary staff]. / Percepción de los pacientes sobre la atención recibida por el personal no sanitario en los centros de salud.

AIMS: To know patients' perceptions about relational aspects and technical procedures when they are attended by the administrative staff in Health Centres. To assess the utility of two ways for measuring satisfaction. MATERIAL AND METHODS: Cross-sectional study carried out in people attending the administrative sections of Health Centres for diverse reasons. Just after the interaction with the administrative they were interviewed using two different questions for assessing their opinions and satisfaction with communicational and technical aspects related with their demands. Descriptive analysis. Significant differences among mean was explored by χ(2) test. Open-ended questions were grouped in categories in a process involving three researchers independently. RESULTS: Over than 90% (360) of the attendees declared to be satisfied or very satisfied with the service received from the staff personal. Nevertheless, among 18-36% gave suggestions for improving the service after their consultation. Independently the domain explored, people suggested the communicational, personal capability, quality and quantity of explanations and waiting time as the main aspects to be improved. CONCLUSIONS: Surveys with open-ended questions are more useful to assess the quality of the attention the citizens receive from no-sanitary staff in Health Centres. These type of questions are also more useful for detecting problems and planning new interventions. Relational and informative issues seem to be the most prioritary areas to improve in this section of Health Centres.

[Early biochemical failure after radical prostatectomy for prostate cancer. Impact factors?]. / Recidiva bioquímica precoz tras prostatectomía radical retropúbica por cáncer de próstata. Factores implicados. Influye el tiempo de espera entre biopsia y cirugía?

UNLABELLED: Does delay from biopsy to surgery have any influence? OBJECTIVES: To determine wether WT may impact on the EBF (before one year) alter RRP in our series, and to study other factors that may impact on this issue. MATERIAL AND METHODS: We study 310 RRP. Inclusion criteria are: one year follow up, no hormonal manipulation neither previous radiotherapy. Patients are divide in two groups attending WT. Group A < 90 days (n: 148), Group B > 90 days (n: 162). We study EBF (2 or more PSA determinations >= 0.2 ng/ml), and the impact of previous PSA, biopsy Gleason, Gleason of the specimen (G), pT stage (pT), and WT. T of Student or W of Wilcoxon are used to determine the homogeneity of the two groups. Chi Square of Pearson to compare the two group's EBF and pT attending to WT and EBF attending to pT. U of Mann Whitney is used to study EBF attending to G. Multivariate logistic regresion (LR) is used to study the impact of the variables on EBF. RESULTS: There are no differences between the two groups in age (p<0.129), PSA (p<0.479), biopsy's Gleason (p<0.913). There are no differences in EBF nor in pT attending to WT. Significant statystical differences are founded in EBF attending to pT and G. T3 tumors have more chance of recurrence than T2. EBF is more frecuent as G increases. In logistic regresion of the global serie, independent variables for progression are: Previous PSA and pT. Nor biopsy's Gleason nor specimen's Gleason, nor WT, impact on the EBF. CONCLUSIONS: Biopsy Gleason and WT do not impact on EBF. WT do not impact on pT. In our serie differences on EBF are lead by previous PSA and pT. Also Gleason of the especimen seems to impact on EBF, but in lower proportion, with no significance in multivariate analysis.

Recidiva bioquímica precoz tras prostatectomía radical retropúbica por cáncer de próstata. Factores implicados. ¿Influye el tiempo de espera entre biopsia y cirugía? / Early biochemical failure radical prostatectomy for prostate cancer. Impact factors?

Objetivos: Estudiar diferentes factores que pueden influir en la recidiva bioquímica precoz (RBP) (primer año tras cirugía), tras prostatectomía radical retropúbica (PRR). Material y métodos: Estudiamos 310 PRR. Criterios de inclusión: al menos un año de seguimiento, ausencia de bloqueo hormonal o radioterapia previa. Los pacientes fueron divididos inicialmente en 2 grupos según el tiempo de espera. Grupo A <90días (n: 148), Grupo B > 90 días (n: 162). Estudiamos RBP (2 o más determinaciones de PSA >= 0,2 ng/ml) y la influencia del PSA previo, el Gleason de la biopsia, el Gleason del espécimen, estadio pT, y tiempo de espera. Para estudiar la homogeneidad existente entre los dos grupos usamos la t de Student o W de Wilcoxon. Estudiamos la RBP y el estadio pT en los dos grupos usando la chi cuadrado de Pearson, que también nos sirve para estudiar en los dos grupos la RBP en relación al estadio pT. El test de la U de mann-Whitney lo usamos para estudiar en la serie global la RBP según el Gleason del espécimen. Por último se realiza una Regresión logística multivariante para estudiar la influencia de todas las variables en la RBP en la serie global. Resultados: No encontramos diferencias entre los dos grupos en edad (p< 0,129), ni PSA (p< 0,479), ni Gleason de biopsia(p<0,913). No se encontraron diferencias en RBP ni en estadio pT según el tiempo de espera. Hallamos diferencias estadísticamente significativas en RBP si estudiamos estadio pT y Gleason de la pieza. Los T3 tienen más incidencia de recurrencia que losT2 y hay más incidencia de RBP según aumenta el Gleason de la pieza. En la regresión logística de la serie global las variables independientes de progresión son: PSA previo y estadio pT. Ni el Gleason de la biopsia ni el Gleason del espécimen, ni el tiempo de espera entre biopsia y cirugía influyen en la RBP. Conclusiones: El Gleason de la biopsia y el tiempo de espera no influyen en la RBP. El tiempo de espera tampoco influye en el estadio T final. En nuestra serie las diferencias en RBP vienen dadas por el PSA previo y pT. El Gleason del espécimen parece influir en la RBP, pero en menor proporción sin significado en el análisis multivariante (au)

Objectives: To determine wether WT may impact on the EBF (before one year) alter RRP in our series, and to study other factors that may impact on this issue. Material and methods: We study 310 RRP. Inclusion criteria are: one year follow up, no hormonal manipulation neither previous radiotherapy. Patients are divide in two groups attending WT. Group A < 90 days (n: 148), Group B > 90 days (n: 162). We study EBF (2 or more PSA determinations >= 0.2 ng/ml), and the impact of previous PSA, biopsy Gleason, Gleason of the specimen (G), pT stage (pT), and WT. T of Student or W of Wilcoxon are used to determine the homogeneity of the two groups. Chi Square of Pearson to compare the two group’s EBF and pT attending to WT and EBF attending to pT. U of Mann Whitney is used to study EBF attending to G. Multivariate logistic regresion (LR) is used to study the impact of the variables on EBF. Results: There are no differences between the two groups in age (p< 0.129), PSA (p< 0.479), biopsy´s Gleason (p<0.913). There are no differences in EBF nor in pT attending to WT. Significant statystical differences are founded in EBF attending to pT and G. T3 tumors have more chance of recurrence than T2. EBF is more frecuent as G increases. In logistic regresion of the global serie, independent variables for progression are: Previous PSA and pT. Nor biopsy´s Gleasonnor specimen´s Gleason, nor WT, impact on the EBF. Conclusions: Biopsy Gleason and WT do not impact on EBF. WT do not impact on pT. In our serie differences on EBF are lead by previous PSA and pT. Also Gleason of the especimen seems to impact on EBF, but in lower proportion, with no significance in multivariate analysis (AU)

Uropatía obstructiva bilateral secundaria a hernia vesical masiva / Bilateral ureterohydronephrosis secondary massive vesical hernia

La hernia vesical no es una patología infrecuente, aparece entre el 0,3 y 3% según los autores. La aparición de hernia vesical masiva constituye una rareza. Presentamos un nuevo caso de fracaso renal secundario a hernia vesical inguinoescrotal con uropatía obstructiva bilateral, analizando la presentación clínica, el esquema diagnostico y el tratamiento de estas hernias (AU)

Bladder hernia is not a rare pathological condition, with a frequency between 0,3 and 3%. Massive bladder hernia is less frequent an very rarely ureterohydronephrosis with this pathology. We will present a case a renal failure secondary to inguinoscrotal bladder hernia with bilateral obstructive uropathy and an analyzed the clinical presentation, the diagnosis and the treatment for those hernias (AU)

[Enterocystoplasty in the treatment of interstitial cystitis]. / La enterocistoplastia en el tratamiento de la cistitis intersticial.

OBJECTIVE: To evaluate supratrigonal cystectomy and enterocystoplasty in patients with interstitial cystitis. METHODS: We reviewed four women with interstitial cystitis with infructuos conservative treatment and performed supratrigonal cystectomy and enterocystoplasty. All the patients fulfilled the NHI criteria with increased voiding frequency by night (mean 7.3 times). In 3 cases urodynamic study was available. We used is the four patients ileon as segment for the enterocystoplasty. RESULTS: Mean postoperative follow up was 60 months. In all cases the suprapubic pain disappeared and night voiding frequency reduced (mean 2.2 times). We don't have mayor complications. One patient needs self catheterism 3 years after surgery. CONCLUSION: In patients with interstitial cystitis to be operated supratrigonal cystectomy and enterocystoplasty is the most effective method.

La enterocistoplastia en el tratamiento de la cistitis intersticial / The ehterocystoplasty in the management of the interstitial cystitis

OBJETIVO: Analizar la cistectomía supratrigonal con enterocistoplastia en los pacientes con cistitis intersticial. MÉTODO: Se revisaron cuatro mujeres diagnosticadas de cistitis intersticial en las que fracasaron los tratamientos conservadores y fueron sometidas a cistectomía supratrigonal con enterocistoplastia. Todas las pacientes cumplían los criterios diagnósticos de la NIH con un aumento de frecuencia miccional nocturna (media 7,3 micciones/noche). Se realizó estudio urodinámico en tres casos. En las cuatro pacientes se empleó íleon para la enterocistoplastia. RESULTADOS: El seguimiento medio post-operatorio es de 60 meses. En todos los casos desapareció el dolor suprapúbico y la frecuencia miccional nocturna descendió (media 2,2 micciones/ noche). No tuvimos complicaciones quirúrgicas mayores. Una paciente requirió cateterismo intermitente a los tres años de la intervención. Alguna paciente ha presentado episodio de infección urinaria. CONCLUSIONES: Consideramos que en los pacientes con cistitis intersticial que deben ser opera-dos la cistectomía supratrigonal con enterocistoplastia es el método quirúrgico más efectivo (AU)

[Endoscopic resolution of complications caused by urethrovesical suspension]. / Resolución endoscópica de complicaciones en suspensión uretrovesical.

We presented a total of ten women which referred a varied syntomatology secondary to a bladder foreign body due to the suture employed in the stress incontinence surgery in which urethrovesical suspension techniques were performed. In these patients, to six a Marshall-Marchetti-Krantz technique was practised, to three modified Burch procedure and to the left a suspension according to Raz method. It is described the varied clinic they presented, the necessity of endoscopic study to confirm and the results after solving the 90% of these cases using endoscopic techniques. It is concluded that is not mandatory the employment of non absorbable suture to perform the suspension techniques and in the opposite of the usual tendency of the authors recurring to open surgery, this complication can be solved endoscopically and in ambulatory regime in the most of these cases.

Resolución endoscópica de complicaciones en suspensión uretrovesical / Endoscopic resolution of complications in urethrovesical suspension

Presentamos un total de diez mujeres que referían una sintomatología diversa por cuerpo extraño intravesical, debido a la sutura empleada en la cirugía de incontinencia de estrés en las que se realizaron diversas técnicas de suspensión uretrovesical. En estas pacientes, a seis se les había practicado la técnica de Marshall-Marchetti-Krantz 1 , a tres el procedimiento modificado de Burch 2,3 , y a la restante una suspensión según el método de Raz 4 .Se describe la clínica tan variada que presentaron,la necesidad de estudio endoscópico para la confirmación y resultados tras la resolución del 90 por ciento de estos casos mediante técnicas endoscópicas. Se concluye que no es obligado el empleo de sutura irreabsorbible para realizar la técnica de suspensión y que, en contra de la tendencia general de los autores empleando la cirugía abierta, esta complicación se resuelve endoscópicamente y de modo ambulatorio en la mayoría de los casos (AU)

[Distal detubularized sigmoidoplasty (Canarian neobladder). Midterm functional evaluation]. / Sigmoidoplastia distal destubulizada (Neovejiga Canaria). Valoración funcional a medio plazo.

OBJECTIVE: The aim of this report is to evaluate the medium term clinical and urodynamic results of the distal detubularized sigmoid neobladder, which we have called the "Canarian neobladder". METHODS: Since April, 1992, we have performed 26 orthotopic neobladder substitution using this particular technique. Ten patients were excluded from the study: two patients with early cancer progression; one female patient; one patient that had died a few days after the operation and 6 patients with less than 16 months follow-up. The remaining 16 patients were evaluated and had a mean follow-up of 22 months (range 6-54). We have performed clinical, urodynamic, radiographic and metabolic evaluation every six months during the first year and every 12 months thereafter. Clinical evaluation included daytime frequency, daytime and night-time urinary incontinence, urge and patient satisfaction with the clinical results. Flowmetry, cystometry and pressure-flow test were performed. The upper urinary tract was evaluated by renal ultrasound or pyelography. Entero-ureteral reflux was discarded by cystography. The International Continence Society terminology was utilized and clearly specified if otherwise. RESULTS: 87.5% of the patients were continent during the daytime and only two cases had diurnal urinary incontinence. Seventy-five percent of the patients had night-time incontinence and required external devices for its management. At two years follow-up, the mean diurnal frequency was 180 minutes and the mean bladder capacity was 338.2. First sensation was noted at 70.6% of bladder capacity. The neobladder pressure at maximum capacity during the filling phase was less than 30 cm H2O in all cases. Involuntary bladder contractions were demonstrated during cystomanometry in 93.7%. The pressure-flow test demonstrated neobladder contraction in 50% of cases and combined with abdominal straining in 50%. The foregoing allowed application of passive urethral resistance ratio (PURR) parameters, showing mean PURR initial values of 39.1 cm H2O and mean PURR curvature values of 0.17 cm H2O (mil/sec)2. The mean postvoiding urine was 37.5 ml. We diagnosed entero-ureteral reflux in 25% of patients and upper urinary tract dilatation due to a distal ureteral stricture in 2 patients. Mild outlet obstruction was diagnosed in 50% of the cases and were submitted to endoscopic section of the entero-urethral anastomosis. CONCLUSIONS: The distal sigmoid detubularized neobladder achieves a high rate of daytime continence with adequate frequency. However, the night-time incontinence rate was also high. The neobladder functional capacity remained stable throughout follow-up. Voiding was obtained as a result of neobladder contraction; thus postvoiding urine was minimal and patients did not require self-catheterization.

[Ureteral replacement with appendix]. / Sustitución ureteral con apéndice.

OBJECTIVE: The scant references in the literature on the use of the appendix in ureteral substitution prompted us to describe the present case in whom this technique was utilized. METHODS: The surgical technique of appendiceal interposition to repair a defect approximately 10 cm long in the right ureter is described. Following excision of a mass arising from the adnexa that entrapped the ureter at the level of the pelvis, the defect was repaired with the appendix. RESULTS: At two years follow-up, the patient is well and right excretory system function is normal. CONCLUSION: Ureteral repair with the appendix is simple and easy to perform. However, the indications for appendiceal interposition are more limited than those of the classical surgical techniques.

[Non-coordinated voiding syndrome: classification and urodynamic characterization]. / Síndrome de micción no coordinada: clasificación y caracterización urodinámica.

OBJECTIVES: To determine the urodynamic characteristics of uncoordinated voiding. METHODS: Fifty consecutive patients with a diagnosis of uncoordinated voiding were studied; 82% were females and 18% were males; mean age 11.9 years (range 5 to 34 yrs). All patients had a complete urodynamic study including patient history, neurological evaluation, uroflowmetry, cystometry and detrusor pressure/voiding flow. The perineal electromyographic (EMG) activity was recorded throughout the study using surface electrodes. To rule out neurogenic detrusor-sphincter dyssynergy, periurethral sphincter EMG using concentric nail-electrodes was performed in selected cases (20% of the patients). Based on our urodynamic findings, three subtypes of uncoordinated voiding can be distinguished: Type A: micturition is achieved through detrusor involuntary contraction. Type B: micturition is achieved through detrusor voluntary contraction. Type C: micturition is achieved through abdominal straining. RESULTS/CONCLUSIONS: The most important urodynamic findings in uncoordinated voiding, independently of Q max, were the absence of relaxation and increased perineal EMG activity during uroflowmetry. The detrusor pressure/voiding flow test was essential in the classification of uncoordinated voiding. In our series, 58% of the patients were type A, 28% type B and 14% type C.

[Socioeconomic factors: do they influence the demand for care and the degree of satisfaction in primary care?]. / Los factores socioeconómicos: influyen en la demanda asistencial y grado de satisfacción en atención primaria?

A survey of 248 individuals was carried out. They included both males and females aged between 16 and 80 years, and they were selected as a representative sample of the population on care in the health center "Huerta de la Reina" for an error margin of 5% and p less than 0.05. The possible influence of cultural and socioeconomic factors on the opinion of the population about the received attention and the degree of use of health care services was evaluated. 76.2% of our patients are not working, 68.5% are females and 57% are older than 46 years. These two groups show the highest rate of consultation for administrative purposes. The educational level, profession, sex, age and the district of origin do not influence the evaluation of the received care. The patients from the quarter with the lowest socioeconomic status consider that the physician pays less attention to them and have a poorer understanding of the latter's explanations (p less than 0.05). Both factors exert an influence on the evaluation of the new model of care. It was concluded that the socioeconomic characteristics of a population are very important for the development of an integrated type of attention by primary care teams.

[Early detection of congenital luxation of the hip in 15,509 live newborn infants]. / Detección precoz de luxación congénita de cadera en 15.509 recién nacidos vivos.

This paper reports the results of hip examination screening in 15,509 alive newborns during the first 24 hours of life, carried out by the same trained person. Congenital dislocation incidence was 6.18%, with dislocated hips in 3.2% and instable hips in 2.4%. Primaparity was not a predisposing factor. There was a seasonal incidence with a peak in April. Late diagnosis rate was low, but not nil. We insist about the need for a careful hip examination in newborn performed by the same trained persons.