Antegrade endoscopic dilatation as an alternative approach to primary obstructive megaureter. / Dilatación endoscópica anterograda como abordaje alternativo del megauréter obstructivo primario.

OBJECTIVES: Congenital primary obstructive megaureter (POM) is caused by ureterovesical junction stenosis, reduced peristalsis, and the resulting dilatation. Even though ureteral re-implantation remains the current gold standard technique, retrograde dilatation is considered as an effective therapeutic alternative with good results and growing proponents - to the extent it has become the technique of choice in some healthcare facilities. The objective was to present an alternative approach for treatment purposes. MATERIALS AND METHODS: This is the case of a 5-month-old infant with POM and pyonephrosis requiring nephrostomy and intravenous antibiotic therapy. Endoscopic dilatation was carried out by means of a percutaneous drainage in an antegrade fashion and did not require cystoscopy. RESULTS: The procedure was uneventful. During follow-up, ureterohydronephrosis decreased, while ureteral dilatation persisted to a lesser extent with an adequate peristalsis and absence of secondary VUR. The patient has had no symptoms after an 11-month follow-up. CONCLUSIONS: POM antegrade dilatation is an effective alternative in selected patients as it makes the pathology disappear.

OBJETIVOS: El megauréter obstructivo primario congénito (MOP) se produce por la estenosis de la unión ureterovesical, disminución en la peristalsis y su consecuente dilatación. Aunque actualmente el gold standard para el tratamiento de esta entidad sigue siendo el reimplante ureteral, la dilatación retrógrada se considera una alternativa terapéutica eficaz con buenos resultados y que está ganando cada vez más adeptos, siendo en algunos centros la técnica de elección. El objetivo es presentar una alternativa de abordaje para su tratamiento. MATERIAL Y METODOS: Se presenta el caso de un lactante de 5 meses con MOP afecto de pionefrosis que precisa nefrostomía y antibioterapia endovenosa. La dilatación endoscópica se realizó a través del drenaje percutáneo de manera anterógrada sin necesidad de cistoscopia. RESULTADOS: El procedimiento se llevó a cabo sin incidencias. En el seguimiento se apreció una disminución de la ureterohidronefrosis, persistiendo la dilatación del uréter en menor grado con adecuada peristalsis y la ausencia de RVU secundario. Tras 11 meses de seguimiento, permanece asintomático. CONCLUSIONES: La dilatación anterógrada del MOP es una alternativa efectiva en pacientes seleccionados que permite la resolución de la patología.

Dilatación endoscópica anterograda como abordaje alternativo del megauréter obstructivo primario / Antegrade endoscopic dilatation as an alternative approach to primary obstructive megaureter

Objetivos: El megauréter obstructivo primario congénito (MOP)se produce por la estenosis de la unión ureterovesical, disminución enla peristalsis y su consecuente dilatación. Aunque actualmente el goldstandard para el tratamiento de esta entidad sigue siendo el reimplanteureteral, la dilatación retrógrada se considera una alternativa terapéuticaeficaz con buenos resultados y que está ganando cada vez más adeptos,siendo en algunos centros la técnica de elección. El objetivo es presentaruna alternativa de abordaje para su tratamiento. Material y métodos: Se presenta el caso de un lactante de 5 mesescon MOP afecto de pionefrosis que precisa nefrostomía y antibioterapiaendovenosa. La dilatación endoscópica se realizó a través del drenajepercutáneo de manera anterógrada sin necesidad de cistoscopia. Resultados: El procedimiento se llevó a cabo sin incidencias. Enel seguimiento se apreció una disminución de la ureterohidronefrosis,persistiendo la dilatación del uréter en menor grado con adecuada peristalsis y la ausencia de RVU secundario. Tras 11 meses de seguimiento,permanece asintomático. Conclusiones: La dilatación anterógrada del MOP es una alternativa efectiva en pacientes seleccionados que permite la resoluciónde la patología.

Objectives: Congenital primary obstructive megaureter (POM) iscaused by ureterovesical junction stenosis, reduced peristalsis, and theresulting dilatation. Even though ureteral re-implantation remains thecurrent gold standard technique, retrograde dilatation is considered asan effective therapeutic alternative with good results and growing proponents – to the extent it has become the technique of choice in somehealthcare facilities. The objective was to present an alternative approachfor treatment purposes Materials and methods. This is the case of a 5-month-old infantwith POM and pyonephrosis requiring nephrostomy and intravenousantibiotic therapy. Endoscopic dilatation was carried out by means ofa percutaneous drainage in an antegrade fashion and did not requirecystoscopy. Results: The procedure was uneventful. During follow-up, uretero-hydronephrosis decreased, while ureteral dilatation persisted to a lesserextent with an adequate peristalsis and absence of secondary VUR. Thepatient has had no symptoms after an 11-month follow-up. Conclusions: POM antegrade dilatation is an effective alternativein selected patients as it makes the pathology disappear.(AU)

#SoMe4PedSurg: redes sociales, formación e innovación digital en cirugía pediátrica / #SoMe4PedSurg: social media, education, and digital innovation in pediatric surgery

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Revisión sobre la terapia de grupo en niños y adolescentes con trastornos de la conducta alimentaria / Review about Group Therapy in Children and Adolescents with an Eating Disorders

INTRODUCCIÓN: En los últimos años ha aumentado la visibilización de los Trastornos de la Conducta Alimentaria (TCA), se diagnostican mejor, de forma más temprana y han adquirido una gran relevancia en la sociedad, tanto por la gravedad de la clínica psíquica como sus comorbilidades. Son trastornos que requieren, en la mayoría de las ocasiones, un largo camino hacia la recuperación, precisando un abordaje de tratamiento multimodal. OBJETIVO: Realizar una revisión de la bibliografía existente sobre tratamientos psicoterapéuticos en formato grupal en adolescentes con TCA. MATERIAL Y MÉTODOS: Se realiza una búsqueda bibliográfica en PubMed, Cochrane, UptoDate y Google Scholar, incluyendo todos los resultados hasta febrero 2018 (sin límite de fecha de publicación). Los idiomas seleccionados han sido inglés y español. Se han usado las combinaciones de eating disorder (OR anorexia, bulimia, binge) AND adolescence (OR Young) AND group theraphy (OR pshychotheraphy) y los equivalentes en español. RESULTADOS: En la población infanto-juvenil se han publicado cinco trabajos en este ámbito. Uno se trata de una revisión de los tratamientos existentes siendo el resto artículos originales. De entre ellos, dos presentan un enfoque basado en la terapia de rehabilitación cognitiva con buenos resultados en adolescentes. Otro estudio profundiza sobre la autoestima y las habilidades sociales, hallando una mejoría notable en las mismas tras la terapia. Por último, encontramos un trabajo basado en la terapia cognitivo conductual, mejorando tanto la sintomatología alimentaria como la ansiedad asociada, problemas de autoestima o relaciones interpersonales. CONCLUSIONES: Tanto en población adulta como en adolescentes se encuentran beneficios y efectividad demostrada en terapia grupal como parte del tratamiento de trastornos de la alimentación, no obstante, la evidencia es escasa. Es necesario seguir investigando en este ámbito ya que hay poca bibliografía publicada, a pesar de ser frecuente en la práctica clínica

INTRODUCTION: In recent years, eating disorders are more visible. These are diagnosed better and earlier, and have acquired great relevance in society due to the severity of the psychic symptoms and their comorbidities. These disorders require, in most cases, a long road to recovery, requiring a multimodal treatment approach. OBJECTIVE: Review of existing literature for group psychotherapy in adolescents with eating disorders. METHODS: A search is carried out in PubMed, Cochrane, UptoDate and Google Scholar, including the results up to February 2018 (no limit of publication date). The selected languages have been English and Spanish. The key words used were eating disorder (OR anorexia, bulimia, binge) AND adolescence (OR Young) AND group therapy (OR pshychotherapy) and their equivalents in Spanish. RESULTS: We found five publications for children and adolescents' population. One is a review of existing treatments and the rest are original articles. Among them, two presented cognitive rehabilitation group therapy with good results in adolescents. Another study with an approach focused on self-esteem and social skills found a marked improvement after therapy. Finally, we found a work based on cognitive behavioral therapy, improving both food symptomatology and associated anxiety and self-esteem problems or interpersonal relationships. CONCLUSIONS: We found demonstrated evidence for group therapy in adults and adolescents with eating disorders, however, the sources are few. It is necessary to continue researching in this field because, despite being frequent in clinical practice, publications are not so many

Fresh water acclimation elicits a decrease in plasma corticosteroids in the euryhaline Atlantic stingray, Dasyatis sabina.

It is thought that the elasmobranch corticosteroid hormone 1α-hydroxycorticosterone (1α-B) functions as both a glucocorticoid (GC) and mineralocorticoid (MC). Classical antinatriuretic MC activities would run counter to the osmoregulatory strategy of euryhaline elasmobranchs acclimating to fresh water (FW). Therefore we hypothesize that FW acclimation will be accompanied by a decrease in plasma corticosteroids in these animals. However, events that activate the "fight-or-flight" response could mask changes associated with acclimation to lower salinities. To better define the MC role of corticosteroids in elasmobranchs, we designed a transfer system that allows the acclimation of Atlantic stingrays (Dasyatis sabina) from seawater (SW) to FW over 12h while minimizing other extraneous stressors. Blood and interrenal glands were sampled from one group of stingrays 24h after FW transfer, while another group was sampled two weeks after FW transfer. Two other groups served as mock-transfer controls in that they were treated and sampled in the same way, but remained in SW for the entire period. Plasma corticosteroids, osmolality, chloride, and urea were significantly lower in FW-acclimated stingrays (compared to mock-transfer stingrays) 24h after FW transfer. This pattern remained after two weeks in FW, with the exception that plasma corticosteroids returned to pre-acclimation levels. There were no significant differences between experimental groups in interrenal levels of mRNAs encoding key steroidogenic proteins (steroidogenic acute regulatory protein and cholesterol side chain cleavage enzyme). Temporally decreased corticosteroid levels during FW acclimation are consistent with the unique strategy of euryhaline elasmobranchs, whereby lower plasma osmolality is maintained in FW vs. SW environments to reduce hydromineral gradients.

Patients undergoing elective coronary artery bypass grafting exhibit poor pre-operative intakes of fruit, vegetables, dietary fibre, fish and vitamin D.

CHD may ensue from chronic systemic low-grade inflammation. Diet is a modifiable risk factor for both, and its optimisation may reduce post-operative mortality, atrial fibrillation and cognitive decline. In the present study, we investigated the usual dietary intakes of patients undergoing elective coronary artery bypass grafting (CABG), emphasising on food groups and nutrients with putative roles in the inflammatory/anti-inflammatory balance. From November 2012 to April 2013, we approached ninety-three consecutive patients (80% men) undergoing elective CABG. Of these, fifty-five were finally included (84% men, median age 69 years; range 46-84 years). The median BMI was 27 (range 18-36) kg/m(2). The dietary intake items were fruits (median 181 g/d; range 0-433 g/d), vegetables (median 115 g/d; range 0-303 g/d), dietary fibre (median 22 g/d; range 9-45 g/d), EPA+DHA (median 0.14 g/d; range 0.01-1.06 g/d), vitamin D (median 4.9 µg/d; range 1.9-11.2 µg/d), saturated fat (median 13.1% of energy (E%); range 9-23 E%) and linoleic acid (LA; median 6.3 E%; range 1.9-11.3 E%). The percentages of patients with dietary intakes below recommendations were 62% (fruits; recommendation 200 g/d), 87 % (vegetables; recommendation 150-200 g/d), 73% (dietary fibre; recommendation 30-45 g/d), 91% (EPA+DHA; recommendation 0.45 g/d), 98% (vitamin D; recommendation 10-20 µg/d) and 13% (LA; recommendation 5-10 E%). The percentages of patients with dietary intakes above recommendations were 95% (saturated fat; recommendation < 10 E%) and 7% (LA). The dietary intakes of patients proved comparable with the average nutritional intake of the age- and sex-matched healthy Dutch population. These unbalanced pre-operative diets may put them at risk of unfavourable surgical outcomes, since they promote a pro-inflammatory state. We conclude that there is an urgent need for intervention trials aiming at rapid improvement of their diets to reduce peri-operative risks.

SLIT: indications, follow-up, and management

La inmunoterapia específica sublingual (SLIT) ha demostrado ser un tratamiento seguro y eficaz para la alergia respiratoria. Sin embargo, aspectos como la selección del paciente, el empleo de dosis óptimas, sus efectos en el asma y a largo plazo, o el manejo de las reacciones adversas necesitan una mayor investigación. Además, la gran heterogeneidad de estudios realizados con SLIT y la aplicación de los mismos criterios que los que se aplican a la inmunoterapia subcutánea dificultan la obtención de conclusiones precisas y útiles al clínico que prescribe este tratamiento. Por ello, el grupo Quasar (QUality in the Administration of SLIT in Allergic Rhinitis), grupo de alergólogos con amplia experiencia clínica con SLIT, se propuso recoger el estado de la investigación actual y los datos reales disponibles con SLIT. Para ello, se establecieron grupos de trabajo en tres categorías distintas: selección del paciente candidato a recibir SLIT, eficacia del tratamiento y reacciones adversas. Se realizó una búsqueda de artículos representativos para cada tema, localizándose inicialmente en PubMed 850, de los que se seleccionaron y analizaron 314 para extraer la evidencia disponible con SLIT, incorporando finalmente 266 al documento. Se realizó la gradación de la evidencia para cada pregunta clínica según la clasificación de Oxford. El texto resultante fue evaluado hasta en tres ocasiones por todos los miembros del grupo hasta consensuar el documento final que revisa el cuerpo de la evidencia existente hasta el momento sobre SLIT, particularmente con pólenes, sobre los que existe un mayor número de artículos, y, para aquellos aspectos en los que se ha demostrado evidencia insuficiente, propone una alternativa consensuada entre los miembros del grupo Quasar. Finalmente, se proponen algoritmos de selección del paciente candidato para SLIT y de manejo de reacciones adversas (AU)

Specific sublingual immunotherapy (SLIT) has been proved to be a safe and effective approach in respiratory allergy. However, further research is required on aspects such as patient selection, use of optimal dosing, effects on asthma, long-term effects, and management of adverse reactions. In addition, the widely heterogeneous nature of studies on SLIT performed to date and the application of the criteria for subcutaneous immunotherapy make it difficult for the prescribing clinician to draw accurate and useful conclusions. Therefore, the QUASAR Group (QUality in the Administration of SLIT in Allergic Rhinitis), which comprises allergologists with broad clinical experience in SLIT, investigated the latest research findings and available data on this approach. Working parties were formed in 3 different categories: selection of candidates for SLIT, treatment efficacy, and adverse reactions. We performed a PubMed search for articles that were representative of each category and found 850. From these, we finally selected 266 articles, which were reviewed to retrieve data on SLIT. Evidence for each clinical question was graded according to the Oxford classification. The resulting text was evaluated on 3 occasions by all the members of the group until the final version was agreed upon. In this version, we review available evidence on SLIT, particularly with pollens, which is the subject of most articles. In areas where evidence is insufficient, an alternative agreed upon by the members of the QUASAR group is presented. Finally, we propose algorithms for selecting candidates for SLIT and for management of adverse events (AU)

SLIT: indications, follow-up, and management.

Specific sublingual immunotherapy (SLIT) has been proved to be a safe and effective approach in respiratory allergy. However, further research is required on aspects such as patient selection, use of optimal dosing, effects on asthma, long-term effects, and management of adverse reactions. In addition, the widely heterogeneous nature of studies on SLIT performed to date and the application of the criteria for subcutaneous immunotherapy make it difficult for the prescribing clinician to draw accurate and useful conclusions. Therefore, the QUASAR Group (QUality in the Administration of SLIT in Allergic Rhinitis), which comprises allergologists with broad clinical experience in SLIT, investigated the latest research findings and available data on this approach. Working parties were formed in 3 different categories: selection of candidates for SLIT, treatment efficacy, and adverse reactions. We performed a PubMed search for articles that were representative of each category and found 850. From these, we finally selected 266 articles, which were reviewed to retrieve data on SLIT. Evidence for each clinical question was graded according to the Oxford classification. The resulting text was evaluated on 3 occasions by all the members of the group until the final version was agreed upon. In this version, we review available evidence on SLIT, particularly with pollens, which is the subject of most articles. In areas where evidence is insufficient, an alternative agreed upon by the members of the QUASAR group is presented. Finally, we propose algorithms for selecting candidates for SLIT and for management of adverse events.

[Pediatric surgery 2.0]. / Cirugía pediátrica 2.0.

New tools from the web are a complete breakthrough in management of information. The aim of this paper is to present different resources in a friendly way, with apps and examples in the different phases of the knowledge management for the paediatric surgeon: search, filter, reception, classification, sharing, collaborative work and publication. We are assisting to a real revolution on how to manage knowledge and information. The main charateristics are: immediateness, social component, growing interaction, and easiness. Every physician has clinical questions and the Internet gives us more and more resources to make searchs easier. Along with them we need electronic resources to filter information of quality and to make easier transfer of knowledge to clinical practice. Cloud computing is on continuous development and makes possible sharing information with differents users and computers. The main feature of the apps from the Intenet is the social component, that makes possible interaction, sharing and collaborative work.

[Anderson-Hynes pyeloplasty in children under 2 years. Is the laparoscopy the technique of choice?]. / Pieloplastia Anderson-Hynes en menores de 2 años. ¿Es la laparoscopia la técnica de elección?

OBJECTIVE: To analyze if the laparoscopic pyeloplasty is as effective as the open procedure in the ureteropelvic junction obstruction in patients under 2 years of age. PATIENTS AND METHODS: Pyeloplasties performed in children under 2 years of age between 2007 and 2010. Weight, pre and postoperative renal pelvis and calices diameter, operating time, hospital stay and complications were analyzed. RESULTS: We found no statistic differences in weight, complications, or pre and postoperative renal pelvis and calices diameter. However, we found differences in hospital stay and operating time (p<0.05). CONCLUSIONS: Laparoscopic pyeloplasty in children under 2 years of age is a good alternative technique for ureteropelvic junction obstruction, although operating time are still long.

Efectos del bypass gástrico en el esófago de Barrett de pacientes con obesidad mórbida / Effects of gastric bypass for morbid obesity on Barrett esophagus

Background: Besides the weight reducing effects of gastric bypass, it is also a good antireflux procedure since there is no acid production by the gastric pouch and there is no duodenal reflux due to the presence of a Roux en Y. Aim: To describe the effect of gastric bypass on Barrett esophagus among patients with morbid obesity. Material and Methods: Among 896 patients subjected to gastric bypass, 14 patient with a Barrett esophagus diagnosed with endoscopy and biopsy, were followed. A new endoscopy was performed one to 30 months after the surgical procedure. Results: Short (< = 30 mm) and long segment (> = 31 mm) Barrett esophagi were present in eight and six patients, respectively. Gastroesophageal reflux symptoms relieved in 70 percent of these cases in a mean lapse of 6.5 months. There was regression from intestinal metaplasia to car-dial mucosa in six patients (75 percent) with short-segment, and in one patient (16 percent) with long-segment Barrett esophagus. Conclusions: Gastric bypass in patients with morbid obesity and Barrett esophagus is a very good antireflux operation. This was proved by the disappearance of symptoms in almost all patients and by the regression of the intestinal metaplasia which is time and length dependent.

Antecedentes: El bypass gástrico en obesos mórbidos, además de ser una alternativa de cirugía bariátrica, es un buen procedimiento antirreflujo dado que no hay producción de ácido en el reservorio gástrico y no existe reflujo duodenal debido a la Y de Roux. Objetivo: Describir el efecto que tiene el bypass gástrico sobre el esófago de Barrett (EB) de pacientes obesos mórbidos, además discutir nuevos mecanismos fisiopatológicos implicados. Población: De 896 obesos mórbidos operados mediante bypass gástrico resectivo abierto, se siguieron a los 14 pacientes diagnosticados con EB mediante endoscopia e histología. Resultados: De los 14 pacientes con diagnóstico de esófago de Barrett, ocho pacientes presentaban EB corto (< 30 mm) y seis EB largo (> 31 mm). Los síntomas de pirosis y/o regurgitación presentes se resolvieron en un 70 por ciento de los casos en una media de 6,5 meses. Hubo una regresión de la metaplasia intestinal a mucosa cardial normal en seis pacientes (75 por ciento) con EB corto y en un paciente (16 por ciento) con EB largo. Conclusiones: El bypass gástrico es una muy buena alternativa quirúrgica antirreflujo en obesos mórbidos con EB, demostrado por la desaparición de los síntomas en la mayoría de los pacientes y la regresión de la metaplasia intestinal en la mitad de ellos, dependiendo del tiempo y de la longitud. Lo anterior, postulamos, que no sería debido solamente a que no hay producción de ácido en el reservorio gástrico y a que no existe reflujo duodenal, sino que habrían otros mecanismos fisiopatológicos implicados.

Cirugía pediátrica 2.0 / Pediatric surgery 2.0

Las nuevas herramientas que ofrece la web suponen una auténtica revolución en la forma de gestionar la información. El objetivo de este artículo es presentar los diferentes recursos de forma sencilla, proponiendo aplicaciones y ejemplificando con casos concretos su uso en las diferentes etapas de la gestión de la información para el profesional de la cirugía pediátrica: búsqueda, filtro, recepción, clasificación y almacenamiento, compartir, trabajo colaborativo y publicación. Hemos llegado a una auténtica revolución en la forma de gestionar la información y el conocimiento. Las principales características son: inmediatez, componente social, posibilidad creciente de interacción web-usuario, gratuidad y sencillez de manejo. Cualquier médico presenta dudas clínicas con frecuencia. Internet ofrece cada vez más recursos que facilitan las búsquedas. Junto a los buscadores, son necesarios recursos electrónicos que ayuden a fi ltrar información de calidad y faciliten la traslación del conocimiento a la práctica. El almacenamiento de la información en "la nube" está en continuo desarrollo y mejora la posibilidad de compartir información entre diferentes ordenadores y usuarios. Una característica nuclear de las diferentes aplicaciones que ofrecen los nuevos recursos de Internet es el componente social, que permite interactuar, compartir y trabajar de forma colaborativa (AU)

New tools from the web are a complete breakthrough in management of information. The aim of this paper is to present different resources in a friendly way, with apps and examples in the different phases of the knowledge management for the paediatric surgeon: search, fi ter, reception, classification, sharing, collaborative work and publication.We are assisting to a real revolution on how to manage knowledge and information. The main charateristics are: immediateness, social component, growing interaction, and easiness. Every physician has clinical questions and the Internet gives us more and more resources to make searchs easier. Along with them we need electronic resources to filter information of quality and to make easier transfer of knowledge to clinical practice. Cloud computing is on continuous development and makes possible sharing information with differents users and computers. The main feature of the apps from the Intenet is the social component, that makes possible interaction, sharing and collaborative work (AU)

Developmental expression, differential hormonal regulation and evolution of thyroid and glucocorticoid receptor variants in a marine acanthomorph teleost (Sciaenops ocellatus).

Interactions between the thyroid hormone (TH) and corticosteroid (CS) hormone axes are suggested to regulate developmental processes in vertebrates with a larval phase. To investigate this hypothesis, we isolated three nuclear receptors from a larval acanthomorph teleost, the red drum (Sciaenops ocellatus), and established their orthologies as thraa, thrb-L and gra-L using phylogenomic and functional analyses. Functional characterization of the TH receptors in COS-1 cells revealed that Thraa and Thrb-L exhibit dose-dependent transactivation of a luciferase reporter in response to T3, while SoThraa is constitutively active at a low level in the absence of ligand. To test whether interactions between the TH and CS systems occur during development, we initially quantified the in vivo receptor transcript expression levels, and then examined their response to treatment with triiodothyronine (T3) or cortisol. We find that sothraa and sothrb-L are autoregulated in response to exogenous T3 only during early larval development. T3 did not affect sogra-L expression levels, nor did cortisol alter levels of sothraa or sothrb-L at any stage. While differential expression of the receptors in response to non-canonical ligand hormone was not observed under the conditions in this study, the correlation between sothraa and sogra-L transcript abundance during development suggests a coordinated function of the TH and CS systems. By comparing the findings in the present study to earlier investigations, we suggest that the up-regulation of thraa may be a specific feature of metamorphosis in acanthomorph teleosts.

Pieloplastia Anderson-Hynes en menores de 2 años. ¿Es la laparoscopia la técnica de elección? / Anderson hynes pyeloplasty in children under 2 years. is the laparoscopy the technique of choice?

Objetivo. Demostrar que la laparoscopia es tan eficaz como la cirugía abierta en el tratamiento de la estenosis pieloureteral en menores de 2 años. Material y métodos. Pieloplastias en menores de 2 años entre 2007y 2010. Dos grupos: pieloplastia abierta (PA) y pieloplastia laparoscópica(PLap). Se han analizado: peso, diámetro de la pelvis renal y delos cálices pre y postoperatorios, tiempos quirúrgicos, estancia media y complicaciones. Resultados. 35 PA y 13 PLap. No han existido diferencias significativas ni en el peso medio, ni en los diámetros de la pelvis renal y cálices pre ni postoperatorios, ni en las complicaciones. Sí hemos encontrado diferencias estadísticamente significativas en el tiempo quirúrgico medio y la estancia media (p<0,05).Conclusión. Este estudio sugiere que la pieloplastia laparoscópica en niños menores de 2 años es una buena técnica alternativa a la cirugía abierta. El único inconveniente es el mayor tiempo quirúrgico, que irá disminuyendo con la experiencia (AU)

Objective. To analyze if the laparoscopic pyeloplasty is as effective as the open procedure in the ureteropelvic junction obstruction inpatients under 2 years of age. Patients and methods. Pyeloplasties performed in children under2 years of age between 2007 and 2010. Weight, pre and postoperative renal pelvis and calices diameter, operating time, hospital stay and complications were analyzed. Results. We found no statistic differences in weight, complications, or pre and postoperative renal pelvis and calices diameter. However, we found differences in hospital stay and operating time (p<0.05).Conclusions. Laparoscopic pyeloplasty in children under 2 years of age is a good alternative technique for ureteropelvic junction obstruction, although operating time are still long (AU)

Molecular classification of an elasmobranch angiotensin receptor: quantification of angiotensin receptor and natriuretic peptide receptor mRNAs in saltwater and freshwater populations of the Atlantic stingray.

Among the most conserved osmoregulatory hormone systems in vertebrates are the renin-angiotensin system (RAS) and the natriuretic peptides (NPs). We examined the RAS and NP system in the euryhaline Atlantic stingray, Dasyatis sabina (Lesueur). To determine the relative sensitivity of target organs to these hormonal systems, we isolated cDNA sequences encoding the D. sabina angiotensin receptor (AT) and natriuretic peptide type-B receptor (NPR-B). We then determined the tissue-specific expression of their mRNAs in saltwater D. sabina from local Texas waters and an isolated freshwater population in Lake Monroe, Florida. AT mRNA was most abundant in interrenal tissue from both populations. NPR-B mRNA was most abundant in rectal gland tissue from both populations, and also highly abundant in the kidney of saltwater D. sabina. This study is the first to report the sequence of an elasmobranch angiotensin receptor, and phylogenetic analysis indicates that the D. sabina receptor is more similar to AT(1) vs. AT(2) proteins. This classification is further supported by molecular analysis of AT(1) and AT(2) proteins demonstrating conservation of AT(1)-specific amino acid residues and motifs in D. sabina AT. Molecular classification of the elasmobranch angiotensin receptor as an AT(1)-like protein provides fundamental insight into the evolution of the vertebrate RAS.

Regulation of mRNAs encoding the steroidogenic acute regulatory protein and cholesterol side-chain cleavage enzyme in the elasmobranch interrenal gland.

The rate-limiting and regulated step in steroidogenesis, the conversion of cholesterol to pregnenolone, is facilitated by the steroidogenic acute regulatory protein (StAR) and cytochrome P450 cholesterol side-chain cleavage (P450scc). We have isolated cDNAs encoding StAR and P450scc from the Atlantic stingray, Dasyatis sabina, and characterized the steroidogenic activity of the encoded proteins using a heterologous expression system. Green monkey kidney (COS-1) cells cotransfected with D. sabina StAR and human P450scc/adrenodoxin reductase/adrenodoxin fusion (F2) constructs produced significantly more pregnenolone than cells transfected with the F2 construct alone. COS-1 cells transfected with a modified F2 construct (F2DS) in which human P450scc is replaced by D. sabina P450scc had higher rates than cells transfected with D. sabina P450scc alone. In other vertebrates, the stress peptide adrenocorticotropic hormone (ACTH) elicits its effects on corticosteroidogenesis in part through regulation of StAR and P450scc mRNAs. In vitro incubation of D. sabina interrenal tissue with porcine ACTH significantly increased intracellular cAMP and corticosteroid production. As demonstrated by quantitative PCR, ACTH also induced significant increases in mRNA abundance of both StAR and P450scc. Our results suggest that, as in higher vertebrates, chronic ACTH-induced glucocorticoid synthesis in elasmobranchs is mediated by regulation of primary steroidogenic mRNAs. This study is the first to demonstrate steroidogenic activity of an elasmobranch P450scc protein and express a composite elasmobranch steroidogenic pathway in a heterologous cell line. Also, the regulation of StAR and P450scc mRNAs has not previously been demonstrated in elasmobranch fishes.