Serial voiding urosonography in posterior urethral valve diagnosis and management in pediatric patients. / Urosonografía miccional seriada en el diagnóstico y manejo de las válvulas de uretra posterior en pacientes pediátricos.

OBJECTIVES: Report our experience with the use of contrast-enhanced serial voiding urosonography (SVU) for posterior urethral valve (PUV) patient diagnosis and management. MATERIAL AND METHODS: Descriptive retrospective study in 0- to 14-year-old patients with suspected PUV at SVU performed as a first contrast-enhanced urinary tract test with subsequent cystoscopic study. Variables were analyzed using SPSSv22. RESULTS: 18 patients were studied (median age: 6 months). Most patients (15) presented posterior urethral dilatation (mean diameter: 9.56 mm) and a >2 mm gap between proximal and distal urethra. 13 cases had bladder thickening and 9 had VUR. 15 PUV cases, 1 case of distal urethral mucocele, and 1 case of bladder diverticulum obstructing the urethra were diagnosed. Complete PUV resection was performed in 10 patients (66.6%) at the first cystoscopy. The control SVU detected one case of recurrence due to persistence of posterior urethral dilatation. The recurrence case and the 5 incomplete resection cases were treated with a second cystoscopy and resection. The youngest patients required a third resection and cutting balloon dilatation due to residual stenosis. Mean creatinine levels at diagnosis were 0.28 mg/dl. CONCLUSIONS: Serial voiding urosonography (SVU) is a useful complementary test in pediatric patients with posterior urethral valve. Its dynamic nature and its advantages - absence of irradiation, safety, and high sensitivity - make it an ideal imaging test for PUV diagnosis and follow-up.

OBJETIVOS: Comunicar nuestra experiencia con la utilización de la urosonografía miccional seriada (UMS) para el diagnóstico y manejo de pacientes con válvulas de uretra posterior (VUP). MATERIAL Y METODOS: Estudio retrospectivo descriptivo en pacientes entre 0 a 14 años con sospecha de VUP en UMS realizada como primera prueba contrastada de la vía urinaria y con estudio cistoscópico posterior. Las variables se analizaron utilizando SPSSv22. RESULTADOS: Fueron estudiados 18 pacientes (edad mediana de 6 meses). La mayoría de los pacientes (15) presentaban dilatación de la uretra posterior (diámetro medio de 9,56 mm) y diferencia entre uretra proximal y distal mayor de 2 mm. Trece casos tenían engrosamiento vesical y 9 RVU. Se diagnosticaron 15 casos de VUP, 1 caso de mucocele de uretra distal y 1 divertículo vesical que obstruía uretra. Se consiguió resección completa de las VUP en 10 pacientes (66,6%) en la primera cistoscopia. La UMS de control detectó un caso de resección incompleta por persistencia de dilatación de uretra posterior. Este caso y los 5 conocidos con resección incompleta se sometieron a una segunda cistoscopia y resección. El menor de los pacientes requirió una tercera resección y dilatación con balón de corte por estenosis residual. La creatinina media al diagnóstico fue 0,28 mg/dl. CONCLUSIONES: La urosonografía miccional seriada (UMS) es una prueba complementaria útil en pacientes pediátricos con válvulas de uretra posterior. Su carácter dinámico y ventajas: ausencia de irradiación, seguridad y alta sensibilidad; la convierten en una prueba de imagen ideal para el diagnóstico y seguimiento de VUP.

Relevance of silica surface morphology in Ampyra adsorption. Insights from quantum chemical calculations.

Theoretical calculations are performed using the Vienna Ab-initio simulation package (VASP) to understand the mechanisms that control the adsorption of Ampyra drug on the different crystallographic planes of ß-cristobalite: the hydroxylated (111) and (100) surfaces. The Ampyra-silica interaction is most favored on the (100) surface where the entire ring of the molecule interacts with the surface while on the (111) face, lesser exchange and fewer non-polar atoms are involved. Calculations show that the interactions mainly occur at the interface between the Ampyra and the closest silanol groups, according to the formation of the H-bonding interactions. The results indicate that the H-bonds have an important influence on the adsorption of the Ampyra. In consequence, adsorption on the (111) surface is observed to a lesser extent than on the (100) surface according the smaller hydroxyl density.

A first-principles study of pristine and Al-doped activated carbon interacting with 5-Fluorouracil anticancer drug.

The adsorption of the 5-Fluorouracil (5-FU) molecule on the pristine and Al-doped activated carbon (AC) was investigated by using the Vienna Ab-initio Simulation Package. It is found that the 5-FU molecule is only weakly adsorbed on the pristine AC with high adsorption energy and large surface distance. The adsorption of the 5-FU molecule on pristine AC is highly disfavored. In contrast, the molecule shows strong interactions with the Al-doped AC confirmed by the lesser adsorption energy, the charge transfers on the Al-modified zone and the significant changes in the DOS at the Fermi level. The results of our study suggest that the Al dopant increases the adsorption capacity of AC enhancing its interactions with polar atoms of the adsorbate, hence improving its adsorption properties.

[Video-urodynamic evaluation with cystosonography for the study of lower urinary tract dysfunction and other uropathies in children]. / Videourodinamia con cistosonografía para estudio de la disfunción miccional y otras uropatías en niños.

OBJECTIVES: To assess the utility of a new modality of video-urodynamic for study of lower urinary tract dysfunction and other uropathies in kids, replacing voiding cystourethrography by echo-enhanced cystosonography, without ionizing radiations. MATERIAL AND METHODS: Prospective study with simultaneous performance of filling cystometry and cystosonography in 43 kids during the last two years. The sonographic contrast was infused trough the urodynamic catheter. RESULTS: 18 girls and 25 boys, with an average age of 6.18 years (between 2 months and 14 years). The most frequent indication was micturition disfunction in boys and vesicoureteral reflux follow-up in girls. 60,5% presented urodynamic alterations, predominating low bladder accommodations (N = 9), mixed detrusor overactivity (N = 5) and bladder sphincter dyssynergia (N = 4). 15 children had vesicoureteral reflux: 8 passive, 5 active (associated with contractile activity of the detrusor or in the voiding phase) and two mixed. Urethral pathology was seen in two males (urethral valves and stenosis) and two girls (spinning top urethra). A statistically significant relationship was found between the presence of vesicoureteral reflux and other variables: bladder capacity (t = 4.98; p <0.005), detrusor activity (t = 3; p = 0.005), sex (t = 2.543; p = 0.015) and high post-void residual volume (t = 3.75; p <0.005), so that it was more frequent in girls with big bladders, with detrusor activity and high post-void residue. CONCLUSIONS: Cystosonography can replace conventional cystourethrography as an imaging test associated with urodynamics. With this type of exploration we have been able to indicate the treatment to our patients, subjecting them to a single catheterization and without exposing them to ionizing radiation.

OBJETIVOS: Valorar la utilidad de una nueva modalidad de videourodinamia sin radiaciones ionizantes en el estudio de disfunciones miccionales y otras uropatías en niños, sustituyendo cistouretrografía miccional seriada por cistosonografía o urosonografía miccional. MATERIAL Y METODOS: Estudio prospectivo con realización simultánea de cistomanometría de llenado y cistosonografía en 43 niños durante los dos últimos años. El contraste sonográfico fue infundido a través del catéter de urodinamia. RESULTADOS: 18 niñas y 25 niños, con edades de entre 2 meses y 14 años (media de 6,18 años). La indicación más frecuente en los varones fue disfunción miccional y en las niñas seguimiento de reflujo. El 60,5% presentaba alteraciones urodinámicas, predominando baja acomodación vesical (N = 9), hiperactividad del detrusor mixta (N = 5) y disinergia vésico-esfinteriana (N = 4). 15 niños tenían reflujo: 8 pasivos, 5 activos (asociados a actividad contráctil del detrusor o en fase miccional) y dos mixtos. Se vio patología uretral en dos varones (valvas de uretra posterior y estenosis uretral) y dos niñas (uretra en peonza). Se encontró relación estadísticamente significativa entre presencia de reflujo vesicoureteral y otras variables: capacidad vesical (t = 4,98; p <0,005), actividad del detrusor (t = 3; p = 0,005), sexo (t = 2,553; p = 0,015) y residuo postmiccional alto (t = 3,75; p <0,005), siendo más frecuente en niñas con vejigas grandes, con actividad del detrusor y residuo postmiccional alto. CONCLUSIONES: La UMS puede sustituir a la cistouretrografía convencional como prueba de imagen asociada a la urodinamia. Con este tipo de exploración hemos podido indicar un tratamiento a nuestros pacientes, sometiéndolos a un único sondaje y sin exponerlos a radiaciones ionizantes.

Mechanistic insights into the SN2-type reactivity of aryl-Co(iii) masked-carbenes for C-C bond forming transformations.

Herein we describe the synthesis and characterization of a family of C-metalated aryl-Co(iii) enolates, which can be considered as masked-carbenes, using diazoacetates as coupling partners. These species have been proved to be necessary intermediates in the C(sp2)-C(sp3) bond forming event to obtain cyclic amides, taming the elusive Co(iii)-carbene species. The scope of diazoacetates has been exhaustively examined, varying the nature of the ester and the α-substitution, and a clear preference for electron-poor carbene precursors is observed. Exhaustive experimental and theoretical studies indicate that an unprecedented intramolecular SN2-type process governs the formation of the newly formed C-C bond. Furthermore, the key role of several Lewis acids as carboxylate-activating reagents is further explored by DFT calculations.

ß-Cristobalite (001) surface as 4-formaminoantipyrine adsorbent: First principle study of the effect on adsorption of surface modification.

Silica based materials find applications as excipients and particularly as drug delivery agents for pharmaceutical drugs. Their performance can be crucially affected by surface treatments, as it can modify the adsorption (and release) of these formulations. The role of surface modification on the features of 4-formaminoantipyrine (FAA) adsorbed on ß-cristobalite (001) surface is studied by means of simulations based on the Density Functional Theory (DFT). Starting from the results of FAA in interaction with a dehydroxylated surface; a fully hydroxylated surface and a functionalized surface with benzalkonium chloride (BC) surfactant have been added to study the configurational landscape. Calculations suggest that the trend for FAA preferential adsorption on silica surfaces is: dehydroxylated>hydroxylated>BC-functionalized. The potential for hydrogen bonding causes the main contribution to the bonding while dispersion forces present an additional contribution independently of whether the drug is hydrogen-bonded or BC-bonded to the surface. Adsorption takes mainly place through nitrogen atoms in the heterocyclic ring, the carbonyl and amine functional groups. Associated mode's shifts and concurrent changes in bond length are also observed showing accordance between electronic and geometrical structure results. BC surfactant reduces the number of formed H-bonds and lowers the attractive molecule-surface interaction being it useful to prevent particle agglomeration and could favor drug release in therapies that requires faster but controlled delivery.

[Utility of urine levels of interleukins in the diagnosis of vesicoureteral reflux: a case-control study in children]. / Utilidad de los niveles urinarios de interleuquinas en el diagnóstico del reflujo vésico-ureteral: estudio de casos y controles en niños.

UNLABELLED: Invasive imaging methods that require catheterization are used for the diagnosis of vesicoureteral reflux. Our aim is to assess the usefulness of interleukin urinary levels for the diagnosis of reflux in children without urinary tract infection. METHODS: Case-control study in children who underwent a voiding cystourethrogram: forty cases diagnosed of reflux and 80 controls. Concentrations of IL-1beta, IL-6 and IL-8 related to creatinine levels (pg/micromol) were determined in urine samples in all. RESULTS: Sixty-two patients were males and fifty-eight females, with a mean age of 2.4 years. Indications for cystography were previous urinary tract infection in 78 cases (65%), prenatal diagnosis in 24 cases (20%) and postnatal diagnosis of uropathy or family history in 18 cases (15.1%). No significant differences were observed between cases and controls in IL-1beta/creatinine and IL-6/creatinine levels. However, IL-8/creatinine levels were almost significant higher in case group (median 3.5 pg/micromol; SD 9.2) than in control group (median 1.54 pg/micromol; SD 3) (P=0.001). The odds ratio was 5.57 (CI95%: 1.51 a 20.60) (X(MH)=2.80; p=0.005). CONCLUSIONS: Urinary levels of IL-8/creatinine are elevated in children with vesicoureteral reflux, even in absence of urinary tract infection. It could be used as a non-invasive marker for detection of subclinical cases of disease.

[Performance improvement project for the introduction of safety devices: interdisciplinary approach and participation of professionals]. / Proyecto de mejora para la introducción de interdisciplinariedad y participación de los profesionales.

OBJECTIVE: Develop a performance improvement project to introduce safety needle tube holder for venous blood collection after evaluation of the professionals. METHODS: Reach: Costa Ponent Primary Care Direction and the Hospital Viladecans Hospital from Institute Català de la Salut. METHOD: Create interdisciplinary group. Design in two phases. First, material selection and assessment of safety devices. Second, implementation and evaluation of the proposed performance improvements. The material was selected using standardized criteria on safety devices, suitability to clinical practice and technical compatibility The assessment was qualitative questionnaire by adapting the Centers for Disease Control and Prevention. RESULT: We evaluated three types of needles, two of them were evaluated by 54 primary care professionals and one for 12 professionals from the hospital. Good acceptance regarding their interaction with technology and patient safety. It was considered effective safety device. The overall rating was satisfactory. Underutilized the material by hospital professionals. There were no differences regarding sex, the hand size, experience, training you received, and type of needle. It prepared a proposal to come in progressively safety needle tube holder in primary care. The evaluation performed in the hospital it was considered insufficient. CONCLUSIONS: Interdisciplinary participation is essential to implement measures to safe care. The safety needle evaluated were effective with respect to security professionals and the patient. The involvement of different levels of the organization have developed a proposal for performance improvement adapted to the needs of our environment.

[Our experience in retroperitoneoscopic total or partial nephrectomies]. / Nuestra experiencia en retroperitoneoscopia para nefrectomías totales y parciales.

The retroperitoneal laparoscopic approach is displacing open surgery and transperitoneal approach for several benign renal conditions. In the past 6 years we have performed 20 procedures, 10 with lateral position and 10 with posterior prone one: 13 total nephrectomies and 7 heminephrectomies in children aged 4,1 years on average. Mean operative time was 200 minutes in partial procedures and 278 in the total ones. Oral feeding was restored to 11,4 hours and average hospital postoperative stay was 1,58 days in total nephrectomies and 2,18 in heminephrectomies. There was no intraoperative bleeding. Complications were two urine leaks, two infections due to residual ureteral stumps and a case of transient hematuria. There were no significant differences between posterior and lateral approaches as to hospital stay, time of onset of oral feeding or complications, although the average operative time was shorter in the posterior approach (mean 170 min, SD 17,3) than in the lateral one (mean 216 min, SD 41) (P=0,024) in total nephrectomies. Retroperitoneoscopy allows a safe access to the kidney and avoids morbidity associated with the transperitoneal access. The posterior approach provides better vascular control, maintains the peritoneum far and allows the procedure with fewer ports, maximizing work space.

Early load mandibular hybrid prosthesis using the Ohio State University acrylic frame requiring no final impression.

BACKGROUND: Although immediate/early loading protocols for dental implants have presented encouraging outcomes, immediate loading procedures may cause discomfort to the patient and may increase the possibility of damage to the surgical site during the impression procedures. The aim of this study was to describe an alternative technique to fabricate a mandibular hybrid prosthesis in three or four days without making any final impression and to evaluate the outcomes of this technique. METHODS: Seven patients aged 41 to 71 years (mean age, 58 +/- 11) were considered for this study. Each patient received five implants for the reconstruction of the edentulous mandible. These implants were placed in the anterior region of an edentulous mandible and restored with a final mandibular hybrid prosthesis in four days using the Ohio State University (OSU) acrylic frame requiring no final impression procedure. The patients were followed up to 19 months after implant placement. RESULTS: No implants were lost, no technical complications were observed and only minor marginal bone loss was noted after an average 15 months. CONCLUSIONS: This clinical study shows that the OSU acrylic frame, which can easily be customized and accommodates variability in arch form, may be an alternative method to restore any edentulous mandible with an early load mandibular hybrid prosthesis.

[Partial duplication of chromosome 4q (q31, q35): Auriculo-acro-renal syndrome]. / Duplicación parcial del cromosoma 4q (q31, q35): síndrome aurículo-acro-renal.

The partial trisomy 4q is a strange chromosomal illness. This illness is caused by the duplication of a portion of chromosome 4. In most of the cases, it is the result of a balanced translocation in one of the progenitors. The "de novo" appearance is less common. We present a patient with a partial "de novo" duplication in the distal segment of the long arm of chromosome 4 (q31, q35), in association with Robertsonian translocation between chromosomes 14 and 21. This association has not been described previously. In the 4q duplication, the relationship between the phenotype and the parts of the duplicated segment is not well defined, although it seems clear that the renal anomalies and/or thumbs abnormalities are a characteristic manifestation. We have reviewed the literature and, of the cases previously described with trisomy q31-35, we came to the conclusion that this region of chromosome 4 may also be involved in constituting the "Syndrome of partial trisomy 4q" or Auriculo-acro-renal Syndrome".

[Quality of medical diagnosis in sick leave certificates for non-occupational diseases and injuries]. / Calidad del diagnóstico médico en la certificación de la incapacidad temporal por enfermedad común y accidente no laboral.

OBJECTIVE: To evaluate the quality of medical diagnosis in the sick leave certificate. DESIGN: Retrospective, observational study. SETTING: Castelldefels Primary Care Centre, Barcelona, Spain. MEASUREMENTS AND INTERVENTIONS: 205 sick leave episodes of patients reported as non-occupational diseases and injuries were analyzed. The diagnosis of the sick leave certificate was checked against the clinical report carried out by the same physician who made out the sick leave certificate. To assess the quality of medical diagnosis, sensitivity, positive predictive value and the percentage of positive agreement were calculated. The variability of these indicators was also assessed according to the duration of the sick leave episode. RESULTS: Simple agreement between the diagnoses of the sick leave certificate and the clinical report was 92%. The sensitivity of the sick leave certificate in relation to the clinical report by diagnostic group ranged from 75% to 97%; positive predictive value, from 81% to 100%; and the percentage of positive agreement, from 86% to 97%. Short-term sick leave episodes (< or =15 days) had lower values than long-term sick leave (>15 days). CONCLUSIONS: Our findings confirm that the quality of diagnosis on the sick leave certificate is high. The availability of more medical information about the reasons for the sick leave episode does not modify the quality of the diagnosis substantially.

[Megacalycosis diagnosed during the study of antenatal hydronephrosis]. / Megacaliosis diagnosticada en el estudio de una hidronefrosis prenatal.

We describe a case of megacalycosis in a newborn female with a probable antenatal ultrasonographic diagnosis of left multicystic dysplastic kidney. Uroradiology, ultrasonography and nuclear medicine studies were performed and diagnosis was established by excretory urogram. We have found only one previously published case of megacalycosis in which diagnosis was made during the postnatal study of antenatal hydronephrosis. Megacalycosis should be included in the differential diagnosis of prenatal hydronephrosis.

[Phenotype heterogeneity in Gitelman's syndrome]. / Variabilidad fenotípica del síndrome de Gitelman.

A family with three offspring affected of Giltelman's syndrome is reported. The phenotypic variability of this entity is emphasized. Moreover, the diagnosis criteria of the syndrome, phathophysiology, and genetics and clinical differences with Bartter's syndrome are stated.

[Intravesical knot of Foley catheter: unusual complication of cystourethrography in children]. / Nudo intravesical en sonda de tipo Foley: una complicación rara de la cistouretrografía en niños.

We report a rare complication of knotting of the urethral catheter inside the urinary bladder of a 3 month old boy who was referred for voiding cystourethrogram. After unsuccessful attempts to remove the catheter, the baby was admitted to surgery. The catheter was removed under anesthesia after gentle but sustained traction. The complications of improper urethral catheterization are described and recommendations are made for their prevention.