[In vitro generation of a human bladder wall substitute by tissue engineering]. / Generación in vitro de un sustituto de pared vesical humana obtenido mediante ingeniería tisular.

INTRODUCTION: Certain urological congenital conditions, such as bladder exstrophy and acquired conditions such as trauma and tumors may require the use of different tissues like small bowel, sigmoid colon or stomach for bladder reconstruction. However, these tissues are often associated to important complications. The aim of this study is to develop a novel substitute of the human bladder wall by tissue engineering. MATERIAL AND METHODS: We first generated primary cell cultures of epithelial and stromal bladder mucosa cells from small tissue biopsies of human bladder by using enzymatic methods based on trypsin-EDTA and collagenase I. Then, a three-dimensional substitute of the bladder mucosa was generated using fibrin-agarose biomaterials. The analysis of the tissue substitutes was carried out at day 14th of development by histological examination of samples stained with hematoxylin-eosin. RESULTS: The use of enzymatic digestion methods allowed us to efficiently generate primary cell cultures of the human bladder epithelial and stromal cells. The proliferation rate was higher in stromal cells as compared to epithelial cells. Once the bladder mucosa substitutes were generated, a good biocompatibility of the stromal and epithelial cells into the biomaterial was found. The histological structure of the bladder wall substitutes was analogue to that of the native human bladder mucosa. CONCLUSIONS: The bladder mucosa substitute generated by tissue engineering showed structural and histological similarities with the native human bladder tissues and open the door to the future therapeutic use of these bioengineered tissues.

[Analysis of the medical decision in abdominal pain suggestive of acute appendicitis]. / Análisis de la decisión médica en el dolor abdominal sugerente de apendicitis aguda.

OBJECTIVES: Application of the theorem of Bayes for the study of the usefulness of complementary quantitative and qualitative assessment of the effectiveness of ultrasound diagnosis in order to provide the clinician with a tool to accurately assess the effectiveness of these tests in diagnosing abdominal pain appendix subject box. METHODS: Retrospective cohort of 184 patients treated from January 2009 to June 2010 for abdominal pain suggestive of acute abdomen, of which 145 were operated. Were established as predictors of appendiceal disease abdominal exploration, ultrasonography and plasma levels of CRP and leukocytes. The statistical methodology developed by the systematic Bayesian prior determination of ROC curve and calculation of odds and post-test probability as pretest probability based on physical examination. RESULTS: The ROC analysis cut-points set of quantitative tests on the values of WBC >12,800 and CRP >1.8 mg/dl. Applying the model to the white cell count increased clinical certainty of this test in 11.3 points and 13.9 PCR. The combined use of both the index rose 32 points. The effectiveness of ultrasound method showed a statistically significant 94% and an increase in diagnostic certainty of 48 points. DISCUSSION: It is recommended to base the development of protocols and clinical guidelines in practice of test ultrasound as first, and joint determination of inflammatory markers, when that was questionable or negative. Further studies are proposed to increase the clinical certainty to reduce laparotomy white and diagnostic delays in this condition.

[Presurgical nasoalveolar molding a child with cleft lip and palate]. / Moldeamiento nasoalveolar prequirúrgico en el niño con fisura labiopalatina.

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.--Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.--To guide the growth of the segments in which the jaw is divided. 3.--Improve lingual function. 4.--Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby's crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero.